1736 Dickerson Boulevard
Suites C and D Monroe, N.C. 28110

(704) 225-8555

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    ​Piedmont Family Dentistry

    1736 Dickerson Boulevard

    Suites C and D Monroe, N.C. 28110

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    Now in our 15th Year!

    New Patient?

    We welcome you! Schedule an appointment
    online with Piedmont Family Dentistry

    Copyright © 2015 Piedmont Family Dentistry 

     

    NEW PATIENT

    INFORMATION

    WELCOME BACK!

     

    We're excited to have you! 

     

    Returning Patient Forms

    You can download Returning Patient Forms on the right. The main form you will need to update will be the "Communucation Consent Form" to download and print out all of the forms we will need to get you started on your dental visit. Once you've completed the forms you can:

     

    • Scan and email them back to us at PatientCare@piedmontdental.com,

    • Fax them to us at (704) 225-8556,

    • or just bring them in at your visit. 

     

    We encourage all of our  patients to arrive 15 minutes early to their appointment. Please bring with you a photo ID for your records. 

     

    Previous Records

    If you have records from your previous office, bring them with you too. 

     

    Special Needs / Medical 

    Premedication: Patients with joint replacements (hip, knee, etc) will more than likely need to be premedicated prior to their dental visit. Please talk to your orthopedic doctor about your premedication requirements. And let us know if we need to call in a refill for you. 

     

    Questions? 
    • Need detailed directions to our office? Click here.

    • Want to know what insurance plans we take? 

    • Have a question that we haven't answered here? Call us (704) 225-8555 during normal business hours, email us at PatientCare@piedmontdental.com or fill out the form below!

     

    Request an Appointment / Office Hours

    Contact us to schedule appointment today. You can call us at (704) 225-8555,  or just fill in the form below and one of our staff will get back to you to confirm an appointment. Please include in your request:

     

    • Your first and last name,

    • A daytime telephone number along with the best time to call,

    • Your insurance information, if any

    • The reason for your visit 

    • The day and time you would like to schedule an appointment. Our office hours are: 

     

    Monday:        8:30 am – 5 pm

    Tuesday:       8:30 am – 5 pm

    Wednesday:  8:30 am – 5 pm

    Thursday:      8:30 am â€“ 3 pm

    Friday and Saturday By Appointment Only*

    New Patient Forms

    Save time by downloading and printing out the new patient forms. to print all of them at once, select the file "All Piedmont Dental Forms". 

    Medical History Form (PDF 1.08 MB)
    Medical History Form (PDF 1.08 MB)
    All Piedmont Dental Forms (PDF 280 KB)
    All Piedmont Dental Forms (PDF 280 KB)
    New Patient Registration Form (PDF 96 KB)
    New Patient Registration Form (PDF 96 KB)
    Appointment/Financial Policy Form (PDF 40 KB)
    Appointment/Financial Policy Form (PDF 40 KB)
    Communication Consent Form (PDF 40 KB)
    Communication Consent Form (PDF 40 KB)
    HIPPA Acknowledgement Form (PDF 20 KB)
    HIPPA Acknowledgement Form (PDF 20 KB)
    Dental History Questionnaire (PDF 36 KB)
    Dental History Questionnaire (PDF 36 KB)
    HIPPA Privacy Notice Form (PDF 40 KB)
    HIPPA Privacy Notice Form (PDF 40 KB)

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