Dental Forms

DENTAL

Download the forms needed for DENTAL VISITS from here:

SPANISH

SPANISH New Patient Office Policies

SPANISH Medical History Form

SPANISH HIPAA forms

SPANISH Dental Care for Children

ENGLISH

ENGLISH New Patient Office Policies

ENGLISH Medical History Form

ENGLISH HIPAA forms

ENGLISH Dental Care for Children

Customer Support
613 E Franklin Blvd
Gastonia, NC 28054
Phone: 704-874-3316

Administrative Office
200 E. Second Avenue
Gastonia, NC 28052
Phone: 704-874-1900
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© 2016 - 2022 Kintegra
Notice of Non Discrimination
Notice of Privacy Practices
This health center is a FQHC Health Center Program grantee under 42 I.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).
Kintegra is an FTCA deemed organization that receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.