Patient Forms

In advance of your first appointment with us, we will need some important information in order to facilitate your treatment.  Since we are a paperless office, our patient forms are collected electronically.  Before you come in for your first appointment, we kindly ask you to complete the following three documents below : (1) patient health history form, (2) HIPAA Privacy notice and (3) orthodontic informed consent.   

You can rest assured that this personal information will be held strictly confidential and only used to assist us in your treatment.  This sensitive information is protected by our advanced cloud-based data storage system which utilizes state-of-the-art encryption software. 

Please call our office to schedule an appointment before you submit these forms.  Thank you, and we look forward to meeting you!

Patient History Form

Before you arrive at our office for your first visit, please complete our online patient history form. By completing this form before you come in, your biographical, financial, medical and dental information will be immediately integrated into your secure electronic patient record. Completing this document before your visit will allow you to privately answer all questions and will expedite your time in our office.

HIPAA Privacy Notice

The Health Insurance Portability and Accountability Act (HIPAA) requires that we maintain the privacy of protected health information and to provide to individuals with notice of our legal duties and privacy practices. Please take a moment to read our Notice of Privacy Practices

Once you have reviewed our Notice of Privacy Practices, please complete the acknowledgement form to indicate that you have read the notice.

Orthodontic Informed Consent

 
This form is not available online at this time.  Please ask our treatment coordinator, Mary Ann, about this form when you come in for your consultation.  Our apologies for this inconvenience.