Patient Forms

If you are a new patient to our office, the attached files contain our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.


Registration Form

Health History

Dental Insurance Agreement

Dental History and Insurance

Privacy Policy



Connect With Us

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Contact Us

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

Ready to come in for an appointment?
Contact us today!

Jon W. Samaha, DMD MMSc
Cosmetic & Family Dentistry
Creating Beautiful Smiles

Concord Dentist, Dr. Jon Samaha is dedicated to family dentistry such as Exams, Teeth Whitening, Veneers and more. We are looking forward to your visit to our Concord, New Hampshire dental office.


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