New Dental Patients
Serving patients at our Northridge office in Lexington, Mountain View Family Dentistry in Buena Vista, and through our mobile dental services across the county.
How to Register
The printable patient application and applicable forms include the following:
- General Consent for Treatment
- Release of Information for transferring or releasing dental records (if applicable)
- Sliding Fee Discount Program Application (If applicable)
- Statement of Support (For patients with no source of income)
- Income Verification Form (For patients that do not receive pay stubs)
- Self-Employment Verification Form (If applicable)
Print completed registration forms and deliver in person, fax to (855) 806-0826, or mail to 25 Northridge Lane, Lexington, VA 24450.