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  • 610-527-2434
  • Robin D. Harshaw, D.M.D. »
  • Winslow Harshaw, D.M.D. »
  • Micaella Schocker, D.M.D. »
  • Kimberly Chermol, D.M.D. »
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  • Office
    • About Our Doctors
    • Our Staff
    • Office Tour
    • Office Policies & Mission
    • Financial & Insurance
    • Map and Directions
    • Appointment Request
  • Patient
    • First Visit
    • Patient Forms
    • Patient Gallery
    • Before & After
    • About Teeth
    • Dental Health
    • FAQ
    • Oral Hygiene
    • Emergency Info
    • Tooth Decay Prevention
  • Treatment
    • General Treatment
    • Early Dental Care
    • Hospital Dentistry
    • Sedation Dentistry
  • Pediatric Dentistry
    • Overview
    • Dental Sealants
    • Fluoride & Your Child
    • Mouthguards for Children
    • Nitrous Oxide for Children
    • Pregnancy & Your Child's Developing Teeth
    • Sleep Apnea & Behavioral Problems in Children
    • Space Maintainers
    • Teething
    • Thumb Sucking & Your Child's Teeth
    • Your Child's First Visit to the Dentist
  • Patient Portal
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    • Glossary
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  • Contact Us

Patient Forms

You may access the following forms to assist us with your child’s dental care. Please print and fill out the forms, and then bring it to your child’s initial appointment.

  • Welcome Form

If your child is coming from a new practice please fill out this form.

  • Transfer records in

If updating your insurance please go to the following link.

  •  Insurance information


Get Adobe Reader These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo above to download.

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    Pediatric & Adolescent Dentistry of the Main Line

    • Pediatric & Adolescent Dentistry of the Main Line - 780 W. Lancaster Ave., Bryn Mawr, PA 19010 Phone: 610-527-2434

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