Patient Forms

Help us get to know your child!

All of our paperwork is now sent electronically when you schedule your child's visit and sent via text message. Please take a moment and fill out our patient information form before your appointment at our Winston-Salem or Kernersville office. If you have any questions along the way, feel free to contact our practice.

Paper Option

If you would like to fill-out a paper copy of our forms, simply email contactus@happyk idssmiles.com and we will send a PDF of all necessary documents. If you would prefer to fill out the forms in our office, we request you arrive 15 minutes prior to your scheduled appointment time.

Paperwork to print and fill out at home

New Patient Form for 1-3 year olds PDF
New Patient Form for 4-12 year olds PDF
New Patient Form for 13 years and older PDF
Dental Cleaning Form PDF
HIPAA and Practice Policies Form PDF
Authorization to Release Information Form PDF
Notice of Privacy Policies PDF

We look forward to seeing you!

Thank you for taking the time to fill out your paperwork ahead of time. We look forward to seeing you at your next visit!

Dr. Gina Spangler
Dr. Gail Rohlfing
Dr. Kate Lambert
Dr. Kelly Lipp
Dr. Angela Baechtold
& The Pediatric Dental Team