New Patient Information
What to Expect
Your first visit to Belknap Dental Associates is an important one as it introduces you to our practice and our friendly staff. During the first visit, we will collect background information like medical history as well as take the time to get to know our doctors. Below you will find additional information to view before your first visit to Belknap Dental Associates. Also, to help ensure your first visit goes as smoothly as possible, we invite you to take a few minutes to explore our website to educate yourself about the some of the dentistry and smile solutions we offer.
In order to make your visit an easy process, you can request an appointment from our website or call our office. Our friendly staff will assist you in getting everything set up.
If you have any questions about your dental insurance coverage, please contact our office and let our staff assist you. Some of the insurances that we accept are:
- Assurant Dental
- Cigna Dental
We offer special financial accommodations to patients who request our interest free budget payment program. Care Credit is the interest free option upon credit approval that we offer to our patients.
If you have any additional questions or would like to receive an application form, please call Diana, our Financial Coordinator, at (603) 742-4735.
Patient FormsThe below patient forms can be printed and completed before your first visit to expedite your check-in process:
- Download New Patient Paperwork
- Dowload Patient Medical UPDATE Form (for EXISTING patients ONLY)
- Download Records Release Form to transfer x-rays TO our office
- Download Records Release Form to transfer x-rays FROM our office
- Download Parent/Legal Guardian Consent for Treatment Form
- Download Personal Representative Designation Form
- Download 18 and over HIPAA and Personal Health Disclosure Form
- Download Personal Health Information Disclosure Agreement Only (must be signed for disclosure of information of anyone over 18 years of age)
- Download Electronic New Patient Paperwork **Can be signed at appointment**
- Download Electronic Updated Medical History Paperwork **Can be signed at appointment**
- Download Electronic Records Release Form to transfer x-rays FROM our office
- Download Electronic Parent/Legal Guardian Consent for Treatment Form
- Download Records Release Form to transfer x-rays TO our office **After finishing, please save and email to the previous dentist.**
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.
We look forward to your first visit!