For your convenience, we have provided the new patient forms below.
If you would like to save some time, please take a few minutes to fill out and print these forms before your first visit to our office.
New Patient Form
New Patient Additional Forms
If you feel your child would benefit from special treatment modifications at their appointment please also fill out and print this special needs intake questionnaire.
Special needs intake questionnaire
If you are here to refer a patient to our practice, please download the following .pdf file and e-mail or fax to our office, or fill out the online submission form.
Dentist referral form
Please let us know if you have any questions or would like clarification on any of these topics. Contact us at Outreach@mysmileland.com or call us at (508) 986-9722.