All patient forms can be requested from our office as an online form and completed securely via your mobile device. Call or message us to request the online forms.
If you choose to use paper, simply print & complete the forms below.
New Patient Packet (pdf)
DownloadOVER 18 years old Medical History Packet (pdf)
DownloadMedical History UPDATE: established patients only (pdf)
DownloadGuardian Authorization Form (Consent to Treatment Without a Parent/Legal Guardian Present) (pdf)
DownloadNitrous Oxide (laughing gas) Consent Form (pdf)
DownloadTooth Extraction Consent Form (pdf)
DownloadSilver Diamine Fluoride (SDF) Consent Form (pdf)
DownloadAuthorization for Release of Dental Records (pdf)
DownloadAbscess & Cellulitis Information for Parents (pdf)
DownloadInformed Refusal of Xrays (pdf)
DownloadFilling Information for Parents (pdf)
DownloadNotice of Privacy Practices-HIPAA (pdf)
DownloadDuxbury Children's Dentistry
95 Tremont Street-Suite 18, Duxbury, MA 02332
Tel. 781-934-7111 Fax. 781-934-7125
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