Patient Forms

 

For your convenience, we have made the following forms available online. Please print and complete the forms, and bring them with you on your first visit to our office. We are located at 800 St.Mary's St., Raleigh, NC.


Phone (919) 832-2575 for your appointment.

 

• Patient Registration Form

• Medical History Form

• Authorization for Release of Information

• Acknowledgement of Receipt

• Financial and Practice Policies

• Photo and Testimony Authorization Release Form

North Carolina Dental Society
American Dental Association
Smiles

Our Raleigh Dental Office Location

Click on map for active Google map and directions.

Map for Dr.Scott C. Earp DDS, PA

Our Raleigh dental office is conveniently located at 800 St. Mary's Street, across from Broughton High School.

 

Ligon Building

The Ligon Building - Raleigh, NC

 

Please call today to schedule an appointment with our friendly staff.

 

Call (919) 832-2575

 

Office Hours:

Monday - Thursday, 7AM-3PM

800 St. Mary's Street, Suite 403
Raleigh, NC 27605