Mainely Teeth
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    • Home
    • About Us
    • Where are we?
    • Forms
    • Home Visits
    • Press
    • Book Now
    • Gallery
    • Contact Us

  • Home
  • About Us
  • Where are we?
  • Forms
  • Home Visits
  • Press
  • Book Now
  • Gallery
  • Contact Us

Mainely Teeth Forms

Dental Home and HIPAA Consent (pdf)Download
Health History (pdf)Download
MaineCare X-Ray Referral Form (pdf)Download
Patient Demographics (pdf)Download
Patient Financial Responsibilities (pdf)Download
Patient Rights and Responsibilities (pdf)Download
SDF Permission Form (pdf)Download
Sliding Scale Eligibility Form (pdf)Download

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Created by Weird Noodle

 Due to overwhelming response and staffing capacity, we are  currently unable to accept new patient appointments at our Root Cellar  Clinic and select satellite locations. We encourage you to submit your  information by clicking “Book Through Maine Health”  to be added to our waitlist for first come-first-serve appointments.  Please call should you have any emergent dental health needs.  

 

 Please note, we are accepting new patients for our Denture Clinic.