Thank you for choosing Southern West Virginia Oral & Maxillofacial Surgeons! Your first appointment will be an important visit for you and for us. During your initial consultation, the surgeon and surgical staff will take time to discuss your concerns and expectations while educating you about your condition. We will go over the surgical and anesthetic procedures available for your particular situation and provide you with a custom, effective treatment plan.
Please arrive at least 15 minutes early to allow time to complete your paperwork, and remember to bring the following items with you to your appointment:
- Your dental and medical insurance cards, if applicable
- Photo ID
- Current list of medications
- Surgical referral, if applicable
- Recent x-rays, if less than one year old
For your convenience, you can click on the forms below, easily fill them out online, then print and bring with you to your first visit.
We look forward to meeting you and your family!
|Health History Form||Patient Information Form|
|Financial Policy||HIPAA Acknowledgment|
Discrimination is Against the Law!
Southern West Virginia Oral & Maxillofacial Surgeons, LTD does not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, disability, or gender. We comply with all applicable federal civil rights laws, and:
- Provide 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)
- Provide free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages
If you need these services, let us know and we will accommodate you!
If you believe that Southern West Virginia Oral & Maxillofacial Surgeons, LTD has failed to provide these services or discriminated in another way based on race, color, national origin, age, disability, or gender, you can file a grievance with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the online complaint portal at http://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services 200 Independence Avenue SW
Room 509F, HHH Building
Washington, D.C. 20201
Toll Free: 1-800-368-1019
Complaint forms are available for free at http://www.hhs.gov/ocr/office/file/index.html