Belmont, MA Dentist

To provide you with the most efficient new patient experience, please complete the On-line forms below before your first appointment. Our Belmont dental team will take comprehensive records and address any concerns or questions you may have. If you have any problems filling out the forms, please contact our dental office in Belmont and we will gladly help you with them.

Required Forms for New Patient Registration:

1. Patient Registration Form

2a. Medical History Form – Child — (Please fill this one out if patient is 17 years old or younger)

2b. Medical History Form – Adult — (Please fill this one out if patient is 18 years old or older)

3a. Dental History – Child — (Please fill this one out if patient is 17 years old or younger)

3b. Dental History – Adult — (Please fill this one out if patient is 18 years old or older)

4. Office Financial Policy Form

5. Acknowledgment of Receipt of Notice of Privacy Practices Form

6. Video Surveillance Patient Acknowledgement and Release Form

7. Photo Consent for In-Office Charting Form

8. General Office Treatment Consent Form

SCHEDULE AN APPOINTMENT