Patient Forms
Download and complete these forms before your first visit to save time.
Welcome to Albion Dental Care. To help us provide you with the best possible care, please download and complete the following forms prior to your first appointment. You may print them at home and bring them to your visit, or arrive a few minutes early to complete them in our office.
Patient Forms
- Patient Information Sheet Basic personal, insurance, and medical history information.
- Financial Assignment Form Insurance assignment and payment responsibility agreement.
- Notice of Privacy Practices How we use and protect your personal health information.
- Acknowledgement of Receipt of Privacy Practices Confirmation that you have received our privacy notice.
- Records Release Form Authorization to transfer dental records from a previous provider.
Dentist Referral Form
If you have questions about any of these forms, please call our Wakefield office at (781) 245-1955 or Burlington office at (781) 229-1955.