Patient Registration

You may print the following Registration Packet, request, or Information Update as needed to assist us with your care, then bring it to your appointment. This will save time on the day of your appointment and allow you to focus on your child while you are here.  

New Patient Registration Packet

Requests for Patient Information

Established Patient Update

Please note: we have updated our Notice of Privacy Practices. Please review them and complete the Acknowledgement form. Thank you!

If your intent is to have someone other than the parent or legal guardian of your child bring them to their appointment, please contact us prior to your appointment.

Service Animals

Coastal Maine Pediatric Dentistry recognizes the importance of service animals and welcomes them in our practice.  Emotional support animals, comfort animals, and therapy dogs are not service animals under Title II and III of the Americans with Disabilities Act.  Please, keep both pets and patients safe by leaving non-service animals at home when visiting medical facilities.  Thank you for your cooperation.



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Coastal Maine Pediatric Dentistry

  • Coastal Maine Pediatric Dentistry - 84 Baribeau Dr., Brunswick, ME 04011 Phone: 207-607-4197 Fax: 207-607-4137

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