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Before, During, & After your visit with us...

Before Your Visit...

Please print out and complete the appropriate patient forms. Email your forms to Admin (at) CharlotteLaserDentist (dot) com or fax to 704 - 392 - 3893 today.

In the event we have an opening sooner, we will have the forms already in the office.

Adult Patient Forms

Child Patient Forms

These forms are in Adobe Acrobat format. If you do not have Acrobat, you may download it by clicking on the graphic link to the left.

Please read the following to be prepared for your visit with us

Directions to prepare your child for treatment

Financial Information

Insurance Information

Please be advised that we are out of network for medical insurance. However, we are more than happy to assist you in filing with your medical or dental insurance.

For medical, please call your insurance carrier and ask them to send you their medical claim form. Different insurance carriers may use different forms, so we don't want things to get delayed for you because your insurance carrier didn't like the form you used.

We will fill out the doctor's office section relating to diagnosis and treatment codes. We will then return the form to you for you to fill out your demographics/insurance information and then mail off to them.

We can and will provide you with a "Letter of Necessity" that has helped many patients get in-network benefits for this procedure.

Below are the codes to give your insurance carrier when checking on your benefits.

Dental Code


Medical Codes

Lip 40806

Tongue 41010

During Your Visit...

Dr. McMurtry will review you and/or your child's medical history. After that, he will perform a thorough intra-oral examination, including looking for any signs of buccal ties, lip ties, or tongue ties. He will then discuss his findings with you.

If Dr. McMurtry confirms and you consent to treatment, we will proceed with treatment.

Unless contraindicated, we will use a topical numbing gel to numb the area that will be treated.  For older children and adults, we typically use an injectable anesthetic (shot) to numb the area after using the topical.

We will swaddle your child to keep arms and legs from interfering with the procedure site(s).

Dr. McMurtry has two assistants in the room to perform the procedure, one whose sole purpose is safely holding your child.  Parents are not in the treatment room during the actual procedure. Dr. McMurtry understands some parents may have some concerns about this policy. However, his focus and attention is for your child and no one else. When there are extra people in the room, it distracts him from what he is there to do, and that is to take excellent care of your child.

The procedure lasts about 15 seconds per site.  During that time, Dr. McMurtry will have you schedule a follow-up visit and get checked out.  By the time you are done with that, Dr. McMurtry will be done with the procedure, and you will be escorted back so that you may feed your child right afterwards

Please be advised this is not designed to be a full nursing session, as we may have another family coming in right after your visit (remember, we have a small office).  If your child is still hungry and you need to continue to feed, we are happy to let you continue to feed your child in our consult or waiting room.

Post-op Information

Dr. McMurtry will go over all post-operative instructions during your visit as well as give you a handout containing all the information he discusses.

On the post-op sheet, there is a link to an online video showing you how to do the stretches.  An electronic link is included here:

After Your Visit...

Should you have any issues

On the post-op sheet is all of Dr. McMurtry's contact information. If you have any questions whatsoever, his cell phone and email address are included. Calll, email, or text him with any concerns.

Follow-up Information

Dr. McMurtry will have you and your child return about two weeks after the procedure for a follow-up visit.  At that visit, he will assess healing and discuss what to be looking for near the completion of healing as well as how much longer after-care will need to be performed


If you have any questions, please do not hesitate to contact us either via phone at 704-392-3883 or email at Admin (at) CharlotteLaserDentist (dot) com