Holt-Tyson Dentistry Welcomes New Patients


CALL (919) 233-1978

A Bright Smile from

Our Family to Yours

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At A Glance

New Patient Forms On-Line

Family Dentistry

Doctors:

Jane R. Holt, D.D.S.

Cynthia Tyson, D.D.S.

Office Hours:

Moday - Thursday

8 AM until 1 PM
2 PM until 5 PM

Contact:

Phone

Fax

(919) 233-1978

(919) 865-0268

Location:

540 New Waverly Place

Suite 200
Cary, North Carolina 27518

For your convenience, the forms to complete for New Patients are included here on-line. Please complete each step in sequence.

Enter the Patient's name and Date of Birth information once here. This data will be transferred to each form for you (if your browser accepts cookies).

First name:

Middle Initial:

Last name:

Date of birth:

FINANCIAL POLICY
The Financial Responsibility has no fields to enter if the Patient name transferred. Click the 'Financial Policy' button. The form will open in a new window. Scroll to the bottom of the window and click 'Print This Page'. Then close the form window.

PATIENT HISTORY
Patient history, as are your medical records, is kept in the strictest confidence. Click 'Patient History' and follow the on-screen instructions. When complete, click 'Print this Page' and close the window.

MEDICAL HISTORY
One reason we chose to post our forms on-line is because most people keep their medical records at home. Please complete the medical history form. Then click 'Print this Page' and close the window.

DENTAL HISTORY
Please click 'Dental History' and complete this last form. Then click 'Print this Page' and close the window.

STEP 6: SIGNATURES Many of the forms have a place for signatures. Sign the forms and bring them with you to your appointment.
We hope you found our Forms-on-Line helpful. If you have questions about how we use this information, please ask one of our business staff for a written copy of our Privacy Policy. We look forward to seeing you at your appointment.