Call Enlighten Dental Care
To Make Your Appointment:


336.765.0904

Hours:

Monday thru Thursday
8:00 am to 4:00 pm

*Friday by appointment only
Location:

1551 Westbrook Plaza Dr., Suite 203

Winston-Salem, NC 27103

Forms

Please use these forms for general information purposes only. Do not email personal health information. Specific patient care questions must be addressed with your doctor during an appointment.

Please download the forms for your initial appointment, complete the forms on your computer with Adobe Acrobat, print out a copy and bring with you. These forms do require Adobe Acrobat.

Patient Health History Form

Our Health History form can be filled out with the latest version of Adobe Acrobat Reader or completed by printing out the form and filling in manually. Please bring with you to your appointment.

Patient Registration Form

Our Patient Registration form can be filled out with the latest version of Adobe Acrobat Reader or completed by printing out the form and filling in manually. Please bring with you to your appointment.

Privacy Policy
Form

Our Privacy Policy form can be viewed and printed using Adobe Acrobat Reader. Please bring with you to your appointment.

Privacy Signature Form

Our Authorization For Release form can be viewed and printed using Adobe Acrobat Reader. Please bring with you to your appointment.

Financial Policy
Form

Our Financial Policy form can be filled out with the latest version of Adobe Acrobat Reader or completed by printing out the form and filling in manually. Please bring with you to your appointment.