New Patient Forms:

All new patients must fill out a Medical and Dental History Form and a HIPAA Privacy Form. You can save yourself some time by completing these forms at home and bringing them with you to your initial appointment. If you have insurance coverage, please fill out the proper insurance form as well (either Child or Adult Insurance Form) so that we can verify your orthodontic benefits.

These forms are in PDF (Portable Document Format) which requires Adobe Acrobat Reader software. If you are unable to read these forms, you can download the free software from the Adobe website .

You can fill out the forms right in your browser window. (Type your information directly into the fields (blanks) and print and/or e-mail.) Or you can simply print the forms from your browser window and fill them in by hand later.

 

• Adult Medical & Dental History Form
• Adult Medical & Dental History Form with e-mail feature
  
• Child Medical and Dental History Form
• Child Medical and Dental History Form with e-mail feature
• Adult Insurance Form
  
• Child Insurance Form
• HIPPA Privacy Policy & HIPPA Privacy Form

Home Practice Information Patient Information Orthodontic Treatment Contact Us Staff First Visit Common Problems FAQs Offices & Tours New Patient Forms Records Office Hours Insurance Methods Directions Appt. / Payments Oral Surgery The Doctor Testimonials Before and After