Patient Forms

We want your experience at our office to be a positive one, and we want to ensure that we give you and your smile all the time necessary to find just the right option for you. In order to maximize your time with our dentist at Kotis Family Dentistry, you can fill out your patient forms before your appointment. You have the option of printing out your forms and bringing them with you on the day of your visit, or you can securely submit them to our office online.

Online Forms
New Patient Packet
6 Month Packet
1 Year Packet
Kotis Care Plan Enrollment Form

PDF Forms
View HIPPA Form
View HIPPA Notice
Medical History Form
Patient Registration Form
Payment Policy Form

Please call our office at 704-873-4271 if you need any help with your paperwork or would just like to schedule your dental appointment in Statesville, North Carolina, with Dr. Amanda Brown Kotis.