Patient Forms

Once you have made your child’s first appointment, please click on each of the

below links in order to download and print each form to bring with you to the

office. We look forward to meeting you and your family!

If you have questions regarding or accessing our forms, e-mail us at or call our main telephone number (508-337-3307).

COVID-19 Screening Form

Medical Dental History Form
HIPAA Consent Form
Consent and Payment Information
Behavioral Assessment Form (for special needs children)

Save time when visiting our office and download your patient forms here.

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Pediatric Dental Center - Dr. Robert Moreau

905B South Main Street
Mansfield, MA 02048
P: 508-337-3307
1029 Pleasant St., Suite 103
Bridgewater, MA 02324
P: 508-807-5274

© 2020 Pediatric Dental Center of Mansfield, PC | Site Design and Development by: Sound Moves Marketing