Registration Forms

Everything You Will Need for Your First

Forms & Useful Info

You will find two forms below that need to be completed in order for Micro Endodontics to treat your dental needs—the New Patient Registration Form and the Medical History Form.

Required for Your First Visit

New Patient Registration Form

Micro Endodontics requires a certain amount of information about our patients prior to beginning treatment. This Registration Form includes requests for basic name and contact information, as well insurance details and payment options. This form may be printed, completed  and brought o an appointment. It may be completed in our office prior to your appointment, however, we ask the patient to arrive 10 minutes early.

Please click the image to download PDF document.

Patient Medical History Form

The Medical History Form requires the patient to provide specific details to any existing or previous medical conditions, prior surgeries or invasive procedures as well as allergies or disorders that could pose a risk or require our Endodontists to make special arrangements prior to beginning treatment.

Please click the image to download PDF document.

For Your Review/Records

HIPAA Compliance Statement

The Health Insurance Portability and Accountability Act of 1996, commonly referred to as HIPAA, required the US Department of Health & Human Services (Read More) to develop regulations protecting the privacy and security of certain health information. Micro Endodontics considers our patient’s health,  personal and financial information to be of the utmost importance. We are a HIPAA Compliant practice and maintain all recommended provisions in protecting our patients privacy and data.

Please click the image to download PDF document.

Questions or Concerns?

In the event you have any questions or if you would like to speak to one of our Endodontists, please feel free to call one of our Practice locations:

Our Andover Location

Our Boston Location