Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. Occasionally, treatment can be performed the same day as the consultation. However, a complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on another day.
Please assist us by providing the following information at the time of your consultation:
- Your referral slip and any x-rays (if applicable)
- A list of your current medications
- If you have medical or dental insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.
IMPORTANT: A parent or guardian must accompany all patients under 18 at every visit.
Please alert the office if you have a medical condition that may be of concern prior to your visit (i.e. diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are on any medication (i.e. heart medications, aspirin, anticoagulant therapy, etc.)
If your dentist or physician has taken x-rays, you may request that they forward them to our office. If there is not enough time, please pick them up and bring them to our office. If additional films are necessary, they can be taken at our facility.
NEW PATIENT DOCUMENTS
NOTICE OF NONDISCRIMINATION
Village Family Dental complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Village Family Dental does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Village Family Dental:
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
– Qualified sign language interpreters
-Written information in other formats (large print, audio, accessible electronic formats, other formats)
Provides free language services to people whose primary language is not English, such as:
-Information written in other languages
If you need these services, contact the Office Manager of this location.
If you believe that Village Family Dental has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Alisa Baxley, Civil Rights Coordinator, by mail or phone at:
2015 Valleygate Drive, Fayetteville, NC 28304
(910) 485-7070 ext.: 2622
Fax: (910) 485-1151
If you need help filing a grievance, Alisa Baxley, Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.isf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SE., Room 509F, HHH Building, Washington, DC 20201, 1-800-868-1019, 800-537-7697 (TDD).
Complaint forms are available at: http://www.hhs.gov/ocr/filing-with-ocr/index.html