68 Maple Street, Essex, VT 05452
ph 802.878.4869

New Patient Forms

For your convenience, you can access our dental forms by clicking on the links below.

You have the option to either complete the forms and submit them online prior to your first visit to our office, or print and complete the forms and bring them with you on your first visit.

Online Submission

Adult Patient Form
Child Patient Form

Print and Complete

Adult Patient Form PDF
Child Patient Form PDF

Privacy Practices Form
Click here to view the Privacy Practices Form in PDF format

Website Accessibility Statement
Click here to view the Website Accessibility Statement in PDF format

New patient forms

Restorative

Cosmetic dentistry allows for a vast range of
services specifically targeted towards improving ones physical appearance.

Learn More

Cosmetic

Cosmetic dentistry allows for a vast range of
services specifically targeted towards improving ones physical appearance.

Learn More

Sedation Dentistry

Cosmetic dentistry allows for a vast range of
services specifically targeted towards improving ones physical appearance.

Learn More

GET STARTED

Have You been referred to our office by a family member or friend?
Contact us to schedule an Initial Consultation.

Request an Appointment