New Patient Forms

If you have a new patient exam scheduled, or need to update your information.  Please print out and complete the following forms.  You may bring these forms in with you to your next appointment, mail, fax or email them back to us.

Dr. K. Alex Poole II, DMD, PA

Attention:  Patient records

2835 Horse Pen Creek Rd. Ste. 106

Greensboro, NC 27410

phone: 336-662-0807

fax: 336-662-0828

email:  dralex@greensborosmiles.com

Patient Registration Form