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  • Home
  • Patient Info 
    • Accepting New Patients
    • New Patient Forms
  • Insurance & Financing 
    • Financing
    • Insurance Accepted
  • Services 
    • Deep Cleanings
    • Dental Hygiene
    • Clear Braces
    • Dental Teeth Whitening
    • Dental Occlusal-Night Guard
    • Dental Composite Fillings
    • Dental Crown
    • Dental Extractions
    • Dental Implant Crowns
    • Dental Implant Bridges
    • Dental Porcelain Bridges
    • Dentures and Partials
  • Reviews
  • …  
    • Home
    • Patient Info 
      • Accepting New Patients
      • New Patient Forms
    • Insurance & Financing 
      • Financing
      • Insurance Accepted
    • Services 
      • Deep Cleanings
      • Dental Hygiene
      • Clear Braces
      • Dental Teeth Whitening
      • Dental Occlusal-Night Guard
      • Dental Composite Fillings
      • Dental Crown
      • Dental Extractions
      • Dental Implant Crowns
      • Dental Implant Bridges
      • Dental Porcelain Bridges
      • Dentures and Partials
    • Reviews

David M. Glasscock, DDS

  • Home
  • Patient Info 
    • Accepting New Patients
    • New Patient Forms
  • Insurance & Financing 
    • Financing
    • Insurance Accepted
  • Services 
    • Deep Cleanings
    • Dental Hygiene
    • Clear Braces
    • Dental Teeth Whitening
    • Dental Occlusal-Night Guard
    • Dental Composite Fillings
    • Dental Crown
    • Dental Extractions
    • Dental Implant Crowns
    • Dental Implant Bridges
    • Dental Porcelain Bridges
    • Dentures and Partials
  • Reviews
  • …  
    • Home
    • Patient Info 
      • Accepting New Patients
      • New Patient Forms
    • Insurance & Financing 
      • Financing
      • Insurance Accepted
    • Services 
      • Deep Cleanings
      • Dental Hygiene
      • Clear Braces
      • Dental Teeth Whitening
      • Dental Occlusal-Night Guard
      • Dental Composite Fillings
      • Dental Crown
      • Dental Extractions
      • Dental Implant Crowns
      • Dental Implant Bridges
      • Dental Porcelain Bridges
      • Dentures and Partials
    • Reviews
    (704) 510-1150
    • Home
    • Patient Info 
      • Accepting New Patients
      • New Patient Forms
    • Insurance & Financing 
      • Financing
      • Insurance Accepted
    • Services 
      • Deep Cleanings
      • Dental Hygiene
      • Clear Braces
      • Dental Teeth Whitening
      • Dental Occlusal-Night Guard
      • Dental Composite Fillings
      • Dental Crown
      • Dental Extractions
      • Dental Implant Crowns
      • Dental Implant Bridges
      • Dental Porcelain Bridges
      • Dentures and Partials
    • Reviews
    • …  
      • Home
      • Patient Info 
        • Accepting New Patients
        • New Patient Forms
      • Insurance & Financing 
        • Financing
        • Insurance Accepted
      • Services 
        • Deep Cleanings
        • Dental Hygiene
        • Clear Braces
        • Dental Teeth Whitening
        • Dental Occlusal-Night Guard
        • Dental Composite Fillings
        • Dental Crown
        • Dental Extractions
        • Dental Implant Crowns
        • Dental Implant Bridges
        • Dental Porcelain Bridges
        • Dentures and Partials
      • Reviews

    David M. Glasscock, DDS

    • Home
    • Patient Info 
      • Accepting New Patients
      • New Patient Forms
    • Insurance & Financing 
      • Financing
      • Insurance Accepted
    • Services 
      • Deep Cleanings
      • Dental Hygiene
      • Clear Braces
      • Dental Teeth Whitening
      • Dental Occlusal-Night Guard
      • Dental Composite Fillings
      • Dental Crown
      • Dental Extractions
      • Dental Implant Crowns
      • Dental Implant Bridges
      • Dental Porcelain Bridges
      • Dentures and Partials
    • Reviews
    • …  
      • Home
      • Patient Info 
        • Accepting New Patients
        • New Patient Forms
      • Insurance & Financing 
        • Financing
        • Insurance Accepted
      • Services 
        • Deep Cleanings
        • Dental Hygiene
        • Clear Braces
        • Dental Teeth Whitening
        • Dental Occlusal-Night Guard
        • Dental Composite Fillings
        • Dental Crown
        • Dental Extractions
        • Dental Implant Crowns
        • Dental Implant Bridges
        • Dental Porcelain Bridges
        • Dentures and Partials
      • Reviews
      (704) 510-1150
      • Home
      • Patient Info
        • Accepting New Patients
        • New Patient Forms
      • Insurance & Financing
        • Financing
        • Insurance Accepted
      • Services
        • Deep Cleanings
        • Dental Hygiene
        • Clear Braces
        • Dental Teeth Whitening
        • Dental Occlusal-Night Guard
        • Dental Composite Fillings
        • Dental Crown
        • Dental Extractions
        • Dental Implant Crowns
        • Dental Implant Bridges
        • Dental Porcelain Bridges
        • Dentures and Partials
      • Reviews
        • New Patient Forms

          Congratulations! Welcome to our practice! We are very excited that you have chosen to be part of our dental family.

           

          To fill out your new patient paperwork, please click the button below.

          New Patient Forms Sign-In
        • Offline Forms

          If you need to fill out our forms offline, please fill out all forms below and bring them with you on your first dental appointment. The Notice of Privacy Act form is for your records only we do not need you to bring this form into the office.

           

          If you are transferring from another office please fill out the form that is for x-ray transfer authorization and send this to your previous dental office so they can submit any and all x-rays that they may have on file; x-rays older then 1 year will be obsolete; if they are bitewings. However, if your previous dentist has a panoramic film or full mouth series on file; we will accept this x-ray because it is good for 3 years.

          Insurance-Disclaimer

          Download

          Medical History Forms

          Download

          Acknowledge Receipt NPP

          Download

          Records-Transfer-Form

          Download

          Records-Transfer-Form

          Download

          Financial-Policy

          Download

          Authorization-for-Release-HIPAA

          Download

          Notice of Privacy Practices

          Download

        Phone:
        704-510-1150 (call or text)

        Email:
        smile@glasscockdental.com

        © 2022 David M Glasscock, DDS. With technical assistance from CLT Geek.

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