Bethlehem Town Family Dental

New Patient Forms

Save time waiting in our office by filling out necessary forms online.

All that you need to bring are your new patient form(s), medical history, two consent forms and signed receipt of privacy practices. The 'Notice of Privacy Practices" is for your convenience and records. This does not need to come with you to your appointment.

Feel free to give us a call if you have any questions.

New Patient Adult

New Patient Child

Medical History

Notice of Privacy Practices

Receipt of Privacy Practices

Information Release Form

Patient Consent

Have Questions? Get in Touch