NOTE: We are not currently accepting new families to our practice. Please do not complete this paperwork until we have you scheduled for an appointment. If you are not currently scheduled, please call or text the office at 207-239-6099 or email office@jpbdmd.com to confirm whether we are able to accept you as a new patient and schedule an appointment. Thank you!
Click here to complete your new patient paperwork online through our secure form!
Or you can download, print, and fill them out:
Registration Form (required)
Medical History Form (required)
HIPAA Form (required)HIPAA Notice of Privacy Practices (for your records only)
If you are looking to release records from our office to another dental office (i.e. you’ve moved or are transferring care to another office), you can fill out the electronic version of our HIPAA Release here.
Or print and fill out the form below. This can be emailed to office@jpbdmd.com or mailed to our office.