Charlotte Dentist Uptown - Dr. Gordon J Roznik, DMD - South Park, Huntersville, Cornelius, Belmont, Matthews, Waxhaw, Rock Hill, General, Sedation, Family, Cosmetic Dentistry

Patient Forms and Information

What to expect at your first appointment at our office.

Review medical and dental history
Take necessary digital x-rays
Dr. Roznik will do a thorough exam
Dr. Roznik, along with the patient, will determine a course of treatment based on patient's needs

To Save Time for You, please download, print and fill out the following forms and bring with you to your first visit with us. To View and Print the forms, you will need Adobe Acrobat Reader, download for FREE!

NEW patient forms, see below!

New Patient Registration Form

New Patient Medical & Dental History Form

New Patient Office Financial Policy Form

New Patient General Procedures Agreement Form

New Patient Privacy Practices Agreement Form

Notice of Privacy Practices
(printing is optional)

Other patient info is available here:

Authorization of Release Information -NEW!

Post Operative Following Extractions

Sedation Concerns

Consent to Sedation