Urgent Dental Care of New Hampshire

New Patient Forms

Save time in our office by filling our new patient registration forms online. We offer our patient registration forms in 2 formats for our patients.

1). The first format just below in the white box is for MANCHESTER PATIENTS ONLY. This will redirect our patients to another site where they can digitally fill out all their registration paperwork without having to print.

2). The Second format is below in the gray boxes which allows patients to print and manually fill out the forms for both Manchester and Somersworth locations.



VA Patient Eligibility Form

Patient Registration Form - Manchester

Patient Registration Form - Somersworth

HIPAA Policy All Offices - READ ONLY

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (603) 627-3927
View the ADA Accessibility Statement