Welcome to Our Office!

PATIENT INFORMATION

DENTAL INSURANCE INFORMATION

EMERGENCY CONTACT INFORMATION

MEDICAL HISTORY

DENTAL HISTORY

ORTHODONTIC GOALS

NOTICE OF PRIVACY ACTS CONSENT FORM

  • Treatment including that given by all health care providers involved in my care
  • Obtaining payment from third party payers including insurance companies and other paying parties.
  • The day-to-day health care practices of the orthodontic practice.