New Patient Forms

[vfb id=’2′]

Please download, print, and fill out the the following forms with you on your first visit:

Patient Information Form

HIPAA Authorization

Consent of Guarantor Agreement

Record Release Form

Following a complete, thorough examination, including a full mouth series of x-rays, we will present a comprehensive treatment plan designed to restore your oral health to an optimum level.

If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader:

 

News & Updates

Contact Information

Office Location:
7996 Highway 19E, Suite 6
Roan Mountain, TN 37687-0410
Phone: 423-772-4167
Phone: 423-772-3059
Fax: 423-772-0178

Mailing Address:
Roan Mountain Dental Center
PO Box 410
Roan Mountain, TN 37687-0410

NEW PATIENTS WELCOME!
CALL 423-772-4167 TO
SCHEDULE AN APPOINTMENT.

Facebook