Patient Forms

Welcome to our practice! We will do everything in our power to provide a positive dental care experience.

 Online forms for your convience

The following Patient Forms can be printed from your computer and filled out at your leisure before your first appointment.

Please bring in a Patient Registration Form, Medical History, and a Financial Policy for each new patient.

If you have any questions do not hesitate to call.

(781) 284-TOOTH

(781) 284-8668

Patient Registration Form

Medical History Form

Financial Policy



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Send Us A Message

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.

Squire Road Family Dental
Ernest Powers Jr., DMD Frank Powers, DMD
Practicing Common-Sense Dentistry

Revere Dentist, Dr. Ernest Powers, DMD is a dental professional dedicated to General, Family & Cosmetic Dentistry such as Dental Exams, Cleanings, X-rays, Fluoride, Dental Makeovers, Teeth Whitening, Veneers, Crowns, & more. Please come and visit Revere, MA dentist Ernest Powers, DMD.


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276 Squire RoadRevere, MA 02151Get Directions781-284-8668


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