Patient Forms

In order for you to have a smooth and efficient consultation, please fill out either the Child or Adult Patient Form. Please email the Laurel Street office at laurel@bellasmile.com and the Page Street office at page@bellasmile.com  if you have any questions or concerns.

• Patient Form (Child)
• Patient Form (Adult)
• COVID-19 Screening Form - Online

Here is our privacy policy for your convenience to read over at any time.

• Notice of Privacy Practices

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