Due to the current state mandate, our office is temporarily closed from 03/18/2020 to 04/19/2020. While we have every intention to return April 20th, we are unsure if this date will stand. Please keep up with us on Facebook and via email for any updates. Thank you for your understanding and take care!
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.

Medical History

Notice of Privacy Practices

Receipt of Privacy Practices

Information Release Form

Dental Savings Plan

Patient Consent

New Patient Adult

New Patient Child

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (518) 776-4939
View the ADA Accessibility Statement