Patient Forms
Patient Forms and Office Policies
To make your visit as smooth and efficient as possible, Galligan Family Dentistry provides all essential forms and policies in one convenient location. Completing required paperwork in advance helps us focus your time in the office on care, conversation, and comfort.
Below you will find downloadable and printable forms for new patients, records requests, financial policies, orthodontic retention guidelines, and privacy information.
If you have questions while completing any form, our team is happy to assist.
New Patient Forms
Please select the appropriate form based on who will be receiving care.
Adult Self Registration
For adult patients completing their own medical and dental history.
We encourage patients to complete these forms prior to arrival whenever possible to reduce check-in time.
Financial Policies
Clear financial expectations are an important part of a smooth patient experience. Please review the policy that applies to your treatment.
General Dental Financial Policy
Outlines payment expectations, insurance processing procedures, out-of-network benefits, and balance timelines.
Orthodontic Financial Policy
Details payment structure, installment options, and policies specific to orthodontic treatment.
We remain committed to transparency and will always review financial details with you prior to beginning treatment.
Privacy Policies
Your privacy matters.
HIPPA Compliance Notice
Our HIPAA Notice of Privacy Practices explains how your health information may be used and disclosed, your rights regarding your medical records, and how we safeguard your protected health information.
If you have questions about privacy or records access, please contact our office directly.
Other Forms & Guidelines
Clear financial expectations are an important part of a smooth patient experience. Please review the policy that applies to your treatment.
Records Transfer Form
Use this form to authorize the release or transfer of dental records, including radiographs and clinical photographs. Timely records transfer helps ensure continuity of care and prevents unnecessary repeat imaging.
Orthodontic Retention Guidelines
Retention is essential to maintaining orthodontic results. This guide explains proper retainer wear, cleaning and storage instructions, and what to do if a retainer is lost or damaged to help preserve alignment long term.
Treatment-Specific Consents
Certain procedures or diagnosed conditions may require additional informed consent documentation. These forms are provided during scheduled visits when relevant to your care plan. Our team will review all treatment recommendations thoroughly and answer any questions before care begins.
Questions or Assistance
At Galligan Family Dentistry, our goal is to make every step of your experience clear, respectful, and straightforward so you can focus on what matters most: your health and your smile. If you need help accessing or completing any of these forms, please contact our office. We are happy to walk you through the process.
Location
Galligan Family Dentistry
11420 Falls of Neuse Rd
Raleigh, NC 27614
Contact
Hours
Monday: 8:30 AM - 5:00 PM
Tuesday: 8:30 AM - 5:00 PM
Wednesday: 8:30 AM - 5:00 PM
Thursday: 8:30 AM - 5:00 PM
Friday: Closed
Saturday: Closed
Sunday: Closed
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