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Duxbury Dental Associates

Duxbury MA Dental Practice

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Patient Forms

Here are the forms you will need for your first appointment.

  • Welcome to Duxbury Dental Associates
  • Patient Registration & Medical History Form
  • Office Policies
  • Informed Consent for General Dental Procedure (2 pages)
  • Acknowledgement of Receipt of Notice of Privacy Practices
  • Notice of Privacy Practices (3 pages for you to keep)
  • New/Change of Insurance Form

Additional Forms

  • Release of Records from Duxbury Dental Associates
  • Request for Release of Records to Duxbury Dental Associates

Please be sure to review, sign and date the above mentioned forms and bring with you to your first appointment.

Again, Thank You for choosing our office to provide your dental care. We look forward to building a long, healthy relationship with you and your family.

The Staff of Duxbury Dental Associates

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Hours of Operation

Monday/Wednesday 8:00-5:00
Tuesday/Thursday 7:30-5:00
Friday 8:00-1:00
Saturday 8:00-1:00 (by appointment)

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Duxbury Dental Associates

24 Bay Road, Duxbury
Massachusetts 02332
Phone: (781) 934-2941

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