Benton & Nelson DDS

New Patient Forms

Save time waiting in our office by filling out necessary forms online. Feel free to give us a call at (336) 760-1277 if you have any questions.

Health History Form

Patient Information Form

Acknowledgement of HIPAA Policies and Procedures

HIPAA Policies and Procedures

Financial Policies

Referral Form

Patient Record Release Form

Call us at (336) 760-1277 to schedule your next appointment.
If you have difficulty using our website, please email us or call us at (336) 760-1277
View the ADA Accessibility Statement