Patient Forms

Contact Us!

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

 
 

If you are a new patient to our office, the attached files contain our new patient bundle with forms that will need to be filled out before we can begin your dental care. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. As a new patient, you will need to fill out 5 total forms. You may download and/or print off a copy of the Notice of Our Privacy Practices for your reference. Thank you. If you are a patient of Dr. Morris Griffin, you will also need to update your paperwork by filling out the 5 forms below. We will do our best to help complete the information for you concerning your dental history and last years insurance information but we must have your permission to do so before we can proceed. This is accomplished by signing our HIPPA agreement.  We are including a more detailed letter explaining the need to update your information so please click on the link below to read it. Thank you in advance for your compliance and understanding.

New Patients & Patients of Dr. Morris Griffin: Please click on each of the following links to the five (5) forms below and print off, complete them, and bring them with you to your first visit.


Contact and Insurance Information

Dental History

Medical History *You may bring a list of your medications for us to copy instead of writing it*   

Authorization to Share Your Information

Consent for HIPPA

An open letter to the patients of Dr. Morris Griffin


As an existing or new patient, if you wish to have a copy of our Notice of Privacy Practices, you may download and/or print off a copy for your records. This document may be found below.

Notice of Privacy Practices


If you wish to have your dental information forwarded to our office
, you may use our form to submit to your previous dental provider. With this form, you will be asking them to forward any applicable x-rays, treatment plans, etc. If applicable, we can accept x-rays in JPEG format. You may have your records faxed to us at 919-286-2237. However, we would prefer if you would please request your records be sent to:
info@steadwillisdmd.com.  

Authorization to Release Your Records to Us

Authorization to Release Records From our Office

 

 


ACCESSIBILITY