Rachel Perentis DDS, PA and Greg Perentis DDS
General Dentists Serving Children
1002 North Church Street
Greensboro, NC 27401
Tel: (336) 335-9990

E-Mail

 
Home

 

 
New Patient Forms
Instructions:

Option 1: You can fill in the fields and then print the form.
Click the link below. If you have Adobe Reader installed on your computer, the form will open in your browser.  Fill in the fields and then print the form. Bring the completed form with you to your appointment.

Option 2: You can print out the form and fill it in by hand.
Click the link below. If you have Adobe Reader installed on your computer, the form will open in your browser.  Print the form. Then fill it out. Bring the completed form with you to your appointment.

English - pdf

Espaņol - pdf

Don't have Adobe Reader?

Free Acrobat Reader