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PATIENT INFORMATION
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603-673-5510
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    • Family Dentistry
      • Cleanings and Checkups
      • Gum Disease
      • TMJ Treatment
      • Root Canal
      • Crowns
    • Cosmetic Dentistry
      • Adult Orthodontics
      • Porcelain Veneers
      • Teeth Whitening
    • Restorative Dentistry
      • Dental Implants
      • Full-Mouth Reconstruction
      • Dentures
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      • Bioesthetic Makeover
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Patient Information

New Patient Special: Exams, X-Rays, & Consultation $79

Learn More

Patient Forms

Please Click the Following links to download our Patient Forms!

Secure Online Forms

Below are all of our available printable or online patient forms made for your convenience. You can simply download your required PDF, print, fill out, and bring in at your next appointment. Or you can also fill out your form online and either email it back to our office or bring it in the next time we see you. This will minimize your time in the waiting room and get you into our exam room smoothly and efficiently.

PLEASE ARRIVE 15 MINUTES PRIOR TO YOUR SCHEDULED APPOINTMENT TO ENSURE YOU HAVE ALL THE NECESSARY FORMS FILLED OUT AND SO THAT YOU CAN MAKE THE MOST OF YOUR APPOINTED TIME WITH YOUR PROVIDER

Welcome Letter! (PDF)

Patient Registration

Patient Registration (PDF)

HIPAA

HIPAA Form for Patient to Sign (PDF)

Dental Records Request and Release Form

Dental Records Request and Release Form (PDF)

Medical Treatment Authorization of Minor

Medical Treatment Authorization of Minor (PDF)

Post Op Instructions (PDF)

* please be sure to fill out the Patient Registration and HIPAA forms

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Amherst Village Dentistry

1 Limbo Lane
Amherst, NH 03031
Get Directions

603-673-5510
Office Hours
Monday – Wednesday 7am – 4pm
Thurs and Fri by appointment only

Serving South New Hampshire, Amherst, Nashua, Bedford, Lowell, Manchester, Milford, Merrimack, Mont Vernon, Wilton, Hollis, New Boston and Lyndeborough.

Cancellations by email or text are not sufficient. Missed appointments without a reasonable notification to our office may be charged $75 or 10% of their appointment fee, whatever is greater. We reserve the right to charge a reservation fee for rescheduling.

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