Patient Resources

New Patient Forms

Download and complete these forms before your first visit
to speed up check-in.

Child Patient Regsitration
Informed Consent
Financial Policy
Cancellation & No Show Policy
Notice of Privacy Practices
Receipt of Notice of Privacy Practices

How to Complete These Forms

Download forms as PDF, print, complete, and bring to your appointment.

Or download, fill digitally, and email back to [email protected] to have them ready when you arrive.

Download the PDF

Click the download button to save the form to your device.

Print & fill out

Print the form and complete it by hand, or fill it out digitally using a PDF editor.

Bring to your appointment

Bring the completed form with you, or email it to us ahead of time.

2359 Mendon Rd

Cumberland, RI 02864

Tuesday - Friday: 8:30am - 5:00pm

Copyright 2026 Cumberland Dental Specialists All Rights Reserved