Dentist Waltham NEW PATIENT FORMS
Check-in Policy: Upon arrival please check-in with the receptionist to help prevent any interuption with your appointment. We recommend arriving 15 minutes early to allow for the check-in process (30 minutes for any new patient). Please remember to bring a valid picture identification of the responsible party including any insurance identification for any patient with insurance coverage at the first visit to help prevent fraudulent activity. You will also need to fill out a Medical History Form and a Financial Agreement Form at your first visit. Please turn off your cell phone in the treatment room. Your cooperation is greatly appreciated.

Do you want to save time at your first visit? You can print and fill out the Medical History Form and Financial Agreement Form on this page by clicking on the Link below. Please feel free to contact our office with any questions or concerns.

The Medical History / Financial Information Form (Page 1) serves as the central repository for useful medical information and is in place to assist the dentist in formulating a diagnosis and providing professional dental care and treatment in a safe manner to the patient. It is vital that your medical information be current and a new form should be filled out every 2 to 3 years. Thank you for your understanding.

The Financial Agreement Form (Page 2) is in place to inform you of your financial obligation to our dental practice. Our goal is to provide the finest care and treatment to all our patients at a reasonable cost in a safe, clean, comfortable, and friendly environment. All charges you incur for any treatment that is provided to you are your responsibility regardless of your insurance coverage. As a dental professional we will always recommend treatment based upon your dental needs and not based on insurance coverage. Please remember that your dental plan may not cover certain procedures regardless of their value to you. Thank you for your assistance.
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* Updated 06/10/2014