Patient Paperwork

Our Patient paperwork is available online.
Please download the paperwork that you require. 

Paper Copies

You may fax any paperwork to Belknap Dental at (603) 742-9911 or bring with you.

Electronic Paperwork 

You may email to xrays@belknapdental.com or bring with you.
Please download and if you click on Fill & Sign on right side of the screen the signature pen will usually be on top to make it easy to sign. After finishing, please save and email to xrays@belknapdental.com.


For your first visit, we will need the following:

  • Completely filled-out New Patient Paperwork
  • Insurance information and an insurance card available to scan or copy
  • If pre-medication is required, please take the appropriate dose as prescribed by your medical doctor before visit.

This is an extended visit reserved for you. If you need to change this appointment, please give us 24 hours notice. We can then offer the appointment to another patient. Thank you for your cooperation and thoughtfulness.


 

Directions to 40 Chestnut Street, Suite 2 Dover , NH 03820 US

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