Patient Forms

Patient Forms

University Dental Associates strives to offer you the convenience you want and deserve from your dentist.

To save you time at our office and speed up your registration process, we ask that you complete your registration forms online and submit them via our secure connection.  Simply click on the links below and complete.

Once you have entered the information, please press the Submit button at the bottom of the form and wait for the message to appear on your screen that reads “Your forms have been successfully submitted”.

Account and Patient Registration

Child History Form

Dental History

Medical History

The following additional forms are available to download, print, and fill out at your convenience:

Privacy Release of Information

Child Health Questionnaire

New Patient Privacy Signature Form

Patient Forms – Orthodontic Patients

The security and privacy of your dental health information is one of our highest concerns and we have taken every precaution to protect it.

Orthodontic patients, you do NOT need to fill out any of the forms in the section above. Please follow the BELOW link to complete your online paperwork.

Orthodontic Registration

Our Dental Offices Near You

University Dental Associates Campus North

807 Spring Forest Rd Suite 600 Raleigh NC 27609 919-954-7177 (p)
919-954-0517 (f)

University Dental Associates Weston

9944 Chapel Hill Road Morrisville NC 27560 919-238-7649 (p)
919-238-7654 (f)

University Dental Associates Interchange

801 Jones Franklin Road Suite 150 Raleigh NC 27606 919-852-0403 (p)
919-852-0562 (f)

University Dental Associates Greensboro

3712 Lawndale Drive Suite D Greensboro NC 27455 336-419-1099 (p)
336-419-1103 (f)

University Dental Associates Kernersville

1030 S Main St Suite B Kernersville NC 27284 336-497-3740 (p)
336-497-3749 (f)

University Dental Associates High Point

2021 Eastchester Drive Suite 101 High Point NC 27265 336-885-6511 (p)
336-885-6577 (f)

University Dental Associates Comp Rehab

131 Miller St Winston-Salem NC 27103 336-837-2680 (p)
336-837-2681 (f)

University Dental Associates Hawthorne

1615 S Hawthorne Rd Winston Salem NC 27103 336-768-3454 (p)
336-768-4986 (f)

University Dental Associates Village Link

2020 Village Link Dr Winston-Salem NC 27106 336-923-4262 (p)
336-923-4281 (f)

University Dental Associates Pediatrics Clemmons/Lewisville

2311 Lewisville Clemmons Rd Suite 301 Clemmons NC 27012 336-631-4770 (p)
336-631-4558 (f)

University Dental Associates Clemmons

6201 Town Center Dr Suite 130 Clemmons NC 27012 336-778-9199 (p)
336-778-9266 (f)

University Dental Associates Benfield

10018 Benfield Road Suite 204 Charlotte NC 28269 704-228-0311 (p)
704-228-0310 (f)

University Dental Associates Mecklenburg Mallard Creek

10320 Mallard Creek Rd Suite 160 Charlotte NC 28262 704-494-7394 (p)
704-494-7399 (f)

University Dental Associates Charlotte University - UDA1

8401 University Executive Park Dr Suite 110 Charlotte NC 28262 704-547-1970 (p)
704-547-1926 (f)

University Dental Associates Charlotte University II - UDA2

8305 University Executive Park Dr Suite 300 Charlotte NC 28262 704-547-1279 (p)
704-549-8390 (f)

University Dental Associates Northlake

9304 Northlake Drive Suite A Charlotte NC 28216 980-221-8430 (p)
980-221-8435 (f)

University Dental Associates Waxhaw

9815 Suzanne Court Waxhaw NC 28173 704-845-1425 (p)
704-845-1580 (f)

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What Our Patients Say

  • my hygienist and dentist were excellent!!!

    Verified Patient

    NC

  • Super professional staff. Went for one visit and immediately made appointments for the rest of my family. Highly recommended.

    Verified Patient

    NC

  • Everyone is friendly and helpful

    Verified Patient

    NC

  • Friendly and efficient staff. The dentist who treated me offered alternatives. Clean, beautiful office.

    Verified Patient

    NC

  • I'm extremely satisfied with my service. Thank you!

    Verified Patient

    NC

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