Northeast Periodontal Associates
Laura Reidy, D.M.D.
Call: (207) 941-2300

Patient Forms


Click the links below to access our patient forms:

By filling out our new patient forms in advance, we are able to provide you with a faster and more convenient experience upon your first visit to our office. If you would like digital versions of these forms, please call our office and we would be happy to send these to you directly via email or text. Otherwise, please feel free to print these forms and mail them into our office prior to your schedule appointment. If you have any questions or concerns, please call us at 207-941-2300.

Patient Information

Medical Insurance

Medical History

Insurance Consent

HIPAA

Dental Insurance

Authorization to Transfer Medical Records

Authorization for Release

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

Office Location

  • Bangor
  • 20 Penn Plaza, Suite 32
  • Bangor, Maine
  • 04401
  • Map & Directions
  • Call: (207) 941-2300