New Patient Information in Bedford

Patient Forms

New Patients are asked to fill out several forms for our records.

To be sure that we have all the information we need to treat you, please download and print one of the following PDF files, fill out your medical information and bring it with you to your first visit.

New Patient FormsAdult Patient Forms Child Patient Forms Financial Policy Insurance Protocol Privacy Policy

Financing Available

PeaksView Dental offers financing options for our patients. CareCredit provides special financing and low monthly payment options, no up-front costs, and no-prepayment penalties. The financing is available for any dental treatment including necessary procedures like root canals or cosmetic procedures like whitening, veneers, dental implants and more.

Apply for CareCredit

What is a PeaksView Perk?

You can receive “PeaksView Perks” when you refer friends and family to our patient-centered dental practice! PeaksView Perks are simple, easy and valuable. They can be applied towards your dental treatment.

How it works:

Whenever you refer a friend or family member to our office who becomes a new patient, you receive $20 PeaksView Perks per new patient that you refer.

That $20 can be applied towards any major dental treatment. In fact, we’ve had patients accumulate enough PeaksView Perks that they were practically able to pay for their Zoom II Deep bleaching treatment!

Call (540) 586-8106 for more information.