Online Forms

All new patients can complete forms online. Forms open in Adobe Acrobat Reader and can be completed at your computer.

Forms can be printed and should be brought with you to your dental appointment with Dr. Tom Anderson. Forms cannot be emailed. We do not allow forms with confidential information to be emailed to our office.

If you prefer, you can fax the forms to us at 336-766-3661.

Please complete these forms. You can type directly on the form, print it, sign it and bring it to your dental appointment. In accordance with HIPAA standards and sound patient privacy policy, forms cannot be emailed from this site.

ADULT - Adobe Acrobat FormatNew Patient (Adult) Insurance / Medical History

CHILD - Adobe Acrobat FormatNew Patient (Child) Insurance / Medical History

EVERYONE

Adobe Acrobat FormatHIPAA Privacy Notice

Adobe Acrobat FormatFinancial Policy

Dr. Tom Anderson, D.D.S. uses Adobe Acrobat forms. You can download the free reader here (new window).