Office Numbers

Boston Office
617-742-3525

Lynnfield Office
781-245-8828

Patient Registration Boston

Boston Patient Registration

Step 1 of 2

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  • WHO WILL BE RESPONSIBLE FOR YOUR ACCOUNT

  • PRIMARY INSURANCE INFORMATION

  • (All insurance companies require an ID # which 95% of the time is your social security number. Your claim will not be processed if blank.)

  • ADDITIONAL OR SECONDARY INSURANCE INFORMATION

  • (All insurance companies require an ID # which 95% of the time is your social security number. Your claim will not be processed if blank.)

  • ASSIGNMENT AND RELEASE

    I, the undersigned certify that I (or my dependent) have insurance coverage with the above and assign directly to Boston Endodontics all insurance benefits, if any, otherwise payable to me for services rendered. I understand that I am financially responsible for all charges whether or not paid by insurance. I hereby authorize the doctor to release all information necessary to secure the payment of benefits. I authorize the use of this signature on all insurance submissions.


Boston Endodontics

Boston Office
5 Longfellow Place, Suite #205
Boston, MA 02114
617-742-3525

Lynnfield Office
50 Salem Street, Building A
Lynnfield, MA 01940
781-245-8828