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 five documents below : (1) patient health history form, (2) HIPAA privacy notice, (3) orthodontic informed consent, (4) supplemental COVID-19 informed consent and (5) supplemental COVID-19 health questionnaire.

You can rest assured that this personal information will be held strictly confidential and only used to assist us in your treatment.  These forms will be immediately integrated into your secure electronic patient record.  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. Completing this document before your visit will allow you to privately answer all questions in the comfort of your home and will expedite your time in our office.  You demographic, financial and health information will be available to us before we see you in the 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

 While orthodontic treatment is extremely safe and generally does not cause any adverse health effects, we want every patient to be aware of what to expect while in treatment.  We will require every patient or guardian to review and acknowledge our Informed Consent for the Orthodontic Patient document.  Please let our treatment coordinator or one of our doctors know if you have any questions regarding any part of this informed consent.   

COVID-19 Forms

We are requiring our existing and new patients to click the two links below and read our supplemental informed consent form and health screening before your next appointment.  We realize the inconvenience but we want you to be aware of the important information contained in these documents.  After you finish reading, we kindly ask that you acknowledge them by electronically signing.  We are happy to answer any questions that you may have.

Supplemental Informed Consent
Supplemental Health and Wellness Questionnaire