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New Patient Forms
Male patient filling out patient forms on his laptop The following forms are provided to our patients online for download. Please print and complete the forms and bring them to your appointment.

If you have questions about any of the paperwork, please give us a call at 781-221-7171 and our staff will be happy to help you.

Online Patient Registration
Online Medical History Form
Online Financial Agreement Form
Online X-ray Release Form
Online HIPAA Acknowledgement Form
Online HIPPA Revision Form
Online COVID Screening Form
Patient Registration Form
Medical History Exam
Financial Agreement and Office Policies
X-Ray Release Form
HIPAA Acknowledgement Form
HIPAA - Full Policy (for patient reference)

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Dental Care of Burlington, 113 Terrace Ave, Unit 1, Burlington, MA 01803 ^ 781-221-7171 ^ dentalcareburlington.com ^ 5/17/2022 ^ Page Terms:facial aesthetics Burlington Ma ^ facial aesthetics Burlington Ma ^