Patient Forms


Middlesex Dental Associates - Middletown, CT

If you are new to our office, the attached file contains our new patient information with forms that will need to be filled out before you arrive for your first visit at our office.  Printing them, filling them out and getting them back to us before your first visit will allow us to attend to your needs more quickly than completing them upon your arrival. Please send them back to us by mail, scan and e-mail them back, or fax back to us before your appointment. Please remember to check on your previous dental records prior to your first visit, the records release form can be mailed directly to your previous dentist.  Please call our office if you have any questions or concerns, Diane or Kim will be glad to help. Thank You.

Patient Forms

Download Adobe Reader This web site uses files in Adobe Acrobat Portable Document Format Download Adobe Reader (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

Contact Us

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

Office Location

  • Middletown
  • 141 Coe Avenue
  • Middletown, CT
  • 06457
  • Map & Directions
  • Call: 860-344-9096