BERKSHIRE DENTAL | Patient Forms

New Patient Forms*

Adult Registration
Minor / Child Registration
Dental and Medical History
Minor / Child Dental and Medical History
Consent for use and disclosure of health information
Minor Consent for use and disclosure of health information
Financial policy
Notice of privacy practices
Acknowledgement of receipt of notice of privacy practices

* Please note each of these forms must be printed and completed for each patient before initial visit to Berkshire Dental Associates.

Missed Appointment Policy

* Appointments cancelled without 48 hours of advance notice or failure to appear for a scheduled appointment will result in a cancellation or no show fee.