New Patient Registration Forms

We recognize that your time is valuable. We will make every attempt to see you at your scheduled appointment time. To save time, download our New Patient Registration Form. Please print the form and complete. When done, simply fax your completed form to us at: 617.278.6593, or, bring it with you to your first appointment.

To print our New Patient Registration Form, please click on the link above. You will need Acrobat Reader, which is a free software program available by clicking the Get Adobe Reader button below.

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1371 Beacon Street, Suite 201, Brookline, Massachusetts 02446
Phone: 617.566.2734 | Fax: 617.278.6593
Email: Office@EhrlichDentalOnline.com

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Ehrlich Dental Associates is a prosthetic and general dentistry practice that serves and welcomes new patients from all over New England and the greater Boston area, including Brookline, Brighton, Allston, Cambridge and Newton. Coolidge Corner dentist, Dr. Marc Ehrlich, provides dental services for cosmetic and restorative dentistry including crowns, bridges, implants, composite fillings, veneers and teeth whitening.