Patient Forms

PATIENT REGISTRATION

Your initial appointment will consist of a consultation with Dr Salloum explaining your diagnosis and treatment options. Occasionally, treatment can be done the same day as the consultation. However, a complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on another day.

You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your visit to our office, we will have your completed form available for your signature.

The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Please click on the link Below to fill our forms:

Bright Dental New Patient Registration Forms

Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e. diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are on any medication (i.e. heart medications, aspirin, anticoagulant therapy, etc.) or require medication prior to dental cleanings (i.e antibiotics, for pre-med.)

Make your dream smile a reality! Call us at 610-317-2400 or make an appointment

Links

24/7 Helpline
Book an Appointment

Office

3739 Bath Pike
Bethlehem, PA 18017

Contact

Open hours

Monday-Thursday: 9am-6pm
Friday: 8am-1pm
Saturday and Sunday: Closed