Patient Information
New Patient Paperwork
Something To Smile About offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- All forms are PDF files. You will need AdobeReader® to view them.
- If you do not already have AdobeReader® installed on your computer,
Click Here to download. - Download the necessary form(s), print them out and fill in the required information.
- Bring the necessary form(s) to your appointment.
(Edit as Needed PDF Form) New Patient Registration Form
Click to Download
(Edit as Needed PDF Form) New Female Patient Registration Form
Click to Download
(Edit as Needed PDF Form) New Male Patient Registration Form
Click to Download
(Edit as Needed PDF Form) Pediatric Patient Registration Form
Click to Download
(Edit as Needed PDF Form) Auto Injury Patient Paperwork
Click to Download
(Edit as Needed Online Form) Review of Symptoms
Click to Complete
(Edit as Needed Online Form) Patient History
Click to Complete
Financial Policy
We firmly believe that financial considerations should not be an obstacle to obtaining the treatment you desire. We are sensitive to the fact that each patient has different needs and have several payment options available so that treatment is accessible to everyone. All financial discussions and arrangements are kept strictly confidential.
Insurance Information
Dental insurance is diverse. Some policies cover only a small percentage of fees, while others cover 50 percent or greater. The more you or your employer pays for premiums, the better the coverage, in most cases. Dental insurance can be confusing, but we'll make it easy for you. Simply bring your card or claim into our office. We'll be happy to tell you what your insurance will cover and file your claim for you.
Something To Smile About
301 Daniel Webster Hwy
Merrimack NH 03054
OFFICE HOURS
Monday
9:00am - 6:00pm
Tuesday
8:00am - 5:00pm
Wednesday
8:00am - 5:00pm
Thursday
8:00am - 5:00pm
Friday
By Appointment Only
Saturday & Sunday
Closed