Please take a minute to print and fill out the patient information form before your first appointment:

 

New Patients

• New Patient Form – Adult PDF
• New Patient Form – Child PDF
• Supplemental Questionnaire – Special needs patient      Down

Patients Starting Treatment

• Patient Cooperation Contract   PDF
• Informed Consent Form     Down
• Financial Payment Options Form    PDF
• Electronic Funds Transfer Form   PDF
• Automated SMS/Email Confirmation Service Form PDF

Special Considerations

• Mouthguard Release Waiver Form    PDF
• Impacted Teeth Informed Consent Form    PDF
• Periodontal Concerns Informed Consent Form  PDF
• Lower Ceramic Braces Waiver Form   PDF
• Premature Removal of Appliances Waiver Form PDF
• Request for Release of Patient Records Form     PDF
• Notice of Privacy Form      PDF
• Advice for Transferring Orthodontic Patients Form           PDF