Patient Registration Forms

Please fill out the following forms and bring them with you to your appointment. You may also fill these out at our office.  Please arrive five to ten minutes early in order to do so.

If you wish you may view the long form of our privacy practices here:

COMMITTED TO EXCELLENCE

Why Choose Raleigh Endodontics?

Dr. Dalzell is trained in providing you with expert care integrating the latest advances in dental technology. His staff maintain an evidence-based treatment approach to ensure patients are both comfortable during procedures and active participants in their ongoing care.

“So many patients assume that root canal procedures are painful and unpleasant, but we’re determined to ensure that your experience with us is comfortable and as pain-free as possible. Our experience and use of state-of-the-art technology ensure that you’re smiling the entire time you’re with us.”