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

Before Your Visit...

Child Patient Forms

This is our all new paperless Child Patient forms.  Once you submit the forms at the end, they will be automatically sent to our secure server.  
In the event we have an opening sooner, we will have the forms already in the office.

Adult Patient Forms

Please print out and complete the appropriate adult new 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.

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 all medical and dental insurance plans. However, we are more than happy to assist you in filing with your medical or dental insurance.

We will provide a super bill to attach to your claim form. Below are the codes to contact your insurance company to check on any reimbursement. Please know BEFORE your appointment if you need a Medical or Dental super bill from us.

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 your insurance company.

We 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

D7961 and D7962

Medical Codes

Lip 40806

Tongue 41010

During Your Visit...

Dr. McMurtry will review your 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 30 seconds.  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 him or her, 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 is listed at the top of the post-op sheet.  Calll or text him with any concerns.

Follow-up Information

Dr. McMurtry will follow-up about two weeks after the procedure.  Follow-ups are typically over the phone.  However, if for ANY reason, you need or want to be seen in-person, just call and let us know.  We are very happy to see you in-office for that follow-up.  At that visit, he will inquire how things are going 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

You can also reach out to Dr. McMurtry on his cell phone.  That number is provided to you on the post-op sheet.