11318 North Community House Road, Suite 210, Charlotte, North Carolina, 28277 Get Directions
704-230-0502 24/7 Online Scheduling

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Patients who have been seen at our office previously may leave the rest of this form blank, unless your dental insurance or personal history has changed since you were last seen.

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Health Questionnaire

PLEASE NOTE: If you have had any x-rays taken elsewhere in the last 12 months: Contact your previous dental office to request that they send ALL xrays to info@apollodentalnc.com prior to your dental appointment to avoid unnecessary out of pocket costs.