Patient Health History and Information Form

“Your comfort and good dental health are dependent upon an accurate knowledge of your medical well being. Many medical situations can affect or be affected by procedures or drugs used for dentistry. Therefore, please fill out the following carefully. Thank you...”

Privacy Consent Form
“By signing this form, you will consent to our use and disclosure of your protected health information to carry out treatment, payment activities, and healthcare operations...”

 

  
 
Most Insurance Accepted
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866-1989

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Dr. Gary Behrend DDS, PA
Address:  5710 Six Forks Road, Suite 101, Raleigh NC 27609
Phone:  919-866-1989
Copyright 2009