New Patient Forms

We are happy to offer our patient forms online. Please feel free to print and fill them out at your convenience before your visit.

New Patient Registration - ADULT

Please download, print and complete this form before your first dental appointment.
Click here to download (88 KB)

New Patient Registration - CHILD

Please download, print and complete this form before your first dental appointment.
Click here to download (95 KB)

Financial and Appointment Policies

Please download, print and complete this form before your first dental appointment.
Click here to download (95 KB)

HIPAA Disclaimer

Please download, print and complete this form before your first dental appointment. This form confirms that you read our Notice of Privacy Practices.
Click here to download (9 KB)

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.
Click here to download (42 KB)

 
If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader:

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  • Morning
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    Early Evening

Our Office

Gane & Karshner Family Dentistry

4309 Ludgate St
Lumberton, NC 28358
Map & Directions
 
Phone: 910-738-2473
 

Office Hours*:
Monday8:00am-5:00pm
Tuesday 8:00am-5:00pm
Wednesday8:00am-5:00pm
Thursday7:30am-2:00pm
Friday 8:00am-12:00pm


*By Appointment Only