Kathryn J. Savitsky, D.M.D., P.A.
15825 Ballantyne Medical Place,
Suite 150
Charlotte, N.C. 28277
Tel: 704.540.2800 
Fax: 704.540.8900

drksavitsky@gmail.com



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Office Hours:
Tues-Thurs: 9-5
Fri: 9-2



 

 




































BBBTM
Better Business Bureau
A+ Business Rating
Proud Member

 

Script

FORMS
 
ON YOUR initial office visit, we will require the completion of forms:

1)  PATIENT HISTORY and Information Form
and
2)  PRIVACY ACT, Informed Consent and Office Practices Form
 
     WE REALIZE that your time is valuable. We have added these two forms for  you to print, complete, and bring with you on your initial visit, if you wish. Both forms available in .pdf and .doc formats. Adobe Reader is available at:
 
Adobe
 
1) PATIENT HISTORY and Information Form:
Please choose to download this form in either format below:

PATIENT HISTORY and Information in PDF
or
PATIENT HISTORY and Information in DOC


 
                   2) HIPAA, informed consent, and office practices:
Please choose to download this form in either format below:

HIPAA, INFORMED CONSENT, AND OFFICE POLICIES in PDF
or
HIPAA, INFORMED CONSENT, AND OFFICE POLICIES in DOCX


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credit

Kathryn J. Savitsky, D.M.D., P.A.
15825 Ballantyne Medical Place, Ste. 150, Charlotte, N.C. 28277

Copyright 2016 kjsdental.com
 

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