Patient Forms

New patients will be asked to fill out several forms regarding your medical history and HIPAA release. Please come 15 minutes early for your fist appointment with us to complete these forms. If you are a recurring patient, you may be asked to update your records by reviewing your patient forms. Call us with any questions.

Online forms are available once we have you registered for an appointment and you provide us with a current email address. Shortly after this process, you will receive an email to register for online access to your forms.

910-350-6944 phone
910-392-3023 fax

email: clinical@junctionparkdentistry.com

ONLINE FORMS ARE AVAILABLE WITH A CURRENT EMAIL ADDRESS ON FILE, ONCE YOU HAVE REGISTERED FOR AN ONLINE ACCOUNT. WE ASK THAT YOU PLEASE COME 15 MINUTES EARLY TO COMPLETE THE FORMS IN OUR OFFICE PRIOR TO YOUR APPOINTMENT, IF YOU ARE UNABLE TO COMPLETE THEM ONLINE.

Please call our office to schedule an appointment.

 

---

SHORT NOTICE CANCELLATION

In order to continue to provide the care and connection to our office for which we are known, effective January 1, 2025 our office will implement a “Short Term Notice Policy”. This applies to current patients and new patients.

If you are running late to must reschedule your appointment, we ask that you notify our office 24 hours in advance of your appointment time of any changes or cancellations being requested to avoid a CANCELLATION FEE of $50.00