Welcome to Belmont Pediatric Dentistry!

Welcome to Belmont Pediatric Dentistry! We are honored that you have chosen us for your child’s dental home!
Please take a moment to review and complete our New Patient Registration packet for your child.  After you click submit, your completed forms will be sent securely to our Patient Care Coordinators who will help ensure you have a great first visit.  If we need any additional information, a member of our team will contact you prior to the appointment. 

Here are some helpful tips to ensure a great first visit:

  • Complete the entire New Patient Registration packet prior to your child’s first visit:

    • New Patient Registration   To help us get to know your child better
    • Medical History
    • Dental History
    • Emergency Contact and Insurance Information
    • Acknowledgement of Privacy Practice   To help us ensure you and your child’s information remain protected
    • Financial Policy
  • A legal guardian needs to be present at the child’s first dental visit. If that is not possible, please call the office prior to visit.
  • Provide detailed insurance information
  • Arrive 10 minutes prior to your child’s scheduled appointment time
  • Bring a copy of your ID along with your insurance card to your child’s appointment
New Patient Registration