Due to overwhelming response, we are unable to accept new ADULT patients at this time

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

COVID-19

For the safety of our staff and high risk patients, we ask that you follow our updated COVID-19 protocols.  Please reschedule your appointment if you have had a close contact exposure, without a negative test.  If you were COVID-19 positive and have completed the five day quarantine, we ask that you do not schedule your appointment until you have zero symptoms and a negative test.  Thank you for understanding as we are doing our best to keep everyone safe during these difficult times.