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Patient Forms

Submit Your Health History Form Online to Your Orthodontist

Save time at the doctor’s office and fill out your registration and health history information online! Take a few minutes to fill out this confidential form, click the “Secure Online Health History Form” at the bottom, and your information will sent to our office with secure encryption.

We will already have your information when you arrive for your first appointment. You will need to provide a signature at the office to verify that the information you submitted online is accurate.

This website is compliant with the Health Insurance Portability and Accountability Act (HIPPAA). All your personal health information is confidential, and will not be shared with anyone, aside from those involved in your treatment, without your consent.

Patient Forms

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

  • Secure Online Health History Form Click Here
  • Download Health History PDF Form PDF

If you’re unable to open PDF files, you can get Adobe Reader® for free.

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