Patient Forms

To expedite your appointment please print and complete our patient registration form and bring it with you to your appointment.

Financial Information

For your convenience, we accept Visa, MasterCard and Discover. We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at 704-892-9500. Many times, a simple telephone call will clear any misunderstandings.

Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.

We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated. We can make arrangements for a monthly payment plan, but that must be implemented prior to the actual procedure.

X-Rays

If your dentist or physician has taken x-rays, you may request that they forward them to our office. If there is not enough time, please pick them up and bring them to our office. If additional films are necessary, they can be taken at our facility.

Scheduling

If you have pain or an emergency situation, every attempt will be made to see you that day.

We try our best to stay on schedule to minimize your waiting. Due to the fact Dr. Rolle provides many types of dental services, various circumstances may lengthen the time allocated for a procedure. Emergency cases can also arise and cause delays. We appreciate your understanding and patience.

Your First Visit

Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. Occasionally, surgery can be performed the same day as the consultation. However, a complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on another day.

Please assist us by providing the following information at the time of your consultation:

  • Your surgical referral slip and any x-rays if applicable.
  • A list of medications you are presently taking.
  • If you have medical or dental insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.

IMPORTANT: All patients under the age of 18 years of age must be accompanied by a parent or guardian at the consultation visit.

A preoperative consultation and physical examination is mandatory for patients undergoing IV anesthesia for surgery. Please have nothing to eat or drink eight hours prior to your surgery. You will also need an adult to drive you home.

Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e., diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are currently taking any medication (i.e., heart medications, aspirin, anticoagulant therapy, etc.).

Ready To Schedule Your First Appointment?

Call our office at 704-892-9500 and our staff will be happy to help you.