Forms

North Point Dental Associates welcomes you into our family! Please see the below forms. These can be filled out directly online ahead of time, or downloaded, filled out and brought with you to your visit. Filling your forms out directly online will save you the most time at your dental visit.

If this is your first visit with us, welcome! Your first visit is a great opportunity to build the foundation of a long lasting dental relationship. Upon arrival of your first visit, we will go over your medical history, patient registration and give you time to get to know your dentist. Dr. Thakkar and her team take great pride in servicing the Triad Area.

Patient Forms:

Please visit our patient portal to register and fill forms out prior to your appointment. This will save you the most time at your visit. No printing necessary!

Fill Out Patient Registration Forms

Print and fill out your new patient paperwork, please download the forms below and bring them with you to your first visit.

  1. New Patient Registration Form
  2. Existing Patient form
  3. Consent For Treatment Form
  4. Parent Policy
  5. Cancellation Policy

Dental Saving Plan

  1. Dental Savings Plan Application / Forms

336-886-1747

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Plans

Dental Savings Plans

No insurance, no problem! North Point Dental Associates offers multiple in house annual savings plans to accommodate our uninsured patients. The plans are effective for 12 months and can be renewed annually. There is a onetime membership fee to sign up and no other monthly expenses for the plan. This is not dental insurance, but rather allows you to receive discounts on all services and get some preventive services such as exams, cleanings and x-rays at no additional cost.

Child

$349 / Yr
  • Two professional cleanings per year
  • Two professional exams per year
  • 1 Set of Routine X-rays
  • 2 Fluoride treatments
  • 1 Emergency exam per year
  • 20% Off other dental services*

Perio

$1,549 / Yr
  • 4 Quadrants of Scaling/Root Planing (Deep cleaning)
  • 3 Perio Maintenances per year
  • Two professional exams per year
  • 1 Set of Routine X-rays
  • 2 Fluoride treatments
  • 1 Emergency exam per year
  • 20% Off other dental services*

Perio Maintenance

$649 / Yr
  • 3 Perio Maintenances Per year
  • Two professional exams per year
  • 1 Set of Routine X-rays
  • 2 Fluoride treatments
  • 1 Emergency exam per year
  • 20% Off other dental services*