Dental Forms | Family Dentist in Methuen, MA
Pleasant Smiles Family and Cosmetic Dentist in Methuen MA

Patient Forms

Byh.bajwas@gmail.com

New Patient Forms

Many of our patients prefer to complete our forms in advance at home. It saves time and make your visit more worthwhile.
All you will need is to fill in the required information, print the forms and bring those in when you visit us. Alternatively, you can fax them to us at (978) 655-3057 prior to your dental appointment.

Pleasant Smiles Health History Form
Pleasant Smiles Notice of Privacy Practices & HIPAA Acknowledgement Form
We will provide a copy of our privacy practices at your appointment, or you may view them using above link.
This form acknowledges that you have received them.
It also provides instructions to Pleasant Smiles Dental about to whom we may disclose information about your treatment.

Please download Adobe Acrobat below to view/print forms:

On The Day Of Your Appointment

Please arrive 15 minutes before your scheduled appointment. This will allow us to finish any paperwork and stay on schedule with your appointment. Please bring the following items with you to your first appointment:

  • Patient Information/Health History Form (If you received from us in the mail or if you downloaded it from our site)
  • Dental Insurance Card
  • Identification such as Driver’s license, military ID or state ID
  • Pleasant Smiles Notice of Privacy Practices & HIPAA Acknowledgement Form
  • Patient Treatment and Financial Policy

If this is your first visit, please see our page on Your First Visit

WE ALWAYS WELCOME NEW PATIENTS. CALL (978) 258-3672

Accept Most Insurance Plans

  • We go the extra mile to help you understand & maximize your insurance.
  • We file the claims on your behalf so that you can get the treatment you need.
  • Flexible options & easy no-interest payment plans with CareCredit & our in house financing. We always quote in advance – no hidden fees.
  • We accept Delta Dental (PPO, Plus, Premier EPO), BCBS, Metlife, Aetna, United Health Care, Cigna, Altus, Guardian, Principal, Mass Health for under 21 and most other insurance plans.