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(401) 943-4111

New  Patient  Forms

In advance of your first appointment with us, we will need some important information in order to generate an electronic patient record.  Since we are a paperless office, our patient forms are collected electronically.  There is no need for you to print these forms. 

You can rest assured that this personal information will be held strictly confidential and only used to assist us in your treatment.  Upon submission, 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 submitting these forms.  Before you arrive at your first visit, we kindly ask you to complete the following two online forms.

1 - Patient Demographic and Health History Form

Before you arrive at our office for your first appointment, please complete our online patient history form.  Completing this document before your visit will allow you to privately answer all questions in the comfort and privacy of your home.  Your demographic, financial and health information will be available to use before we see you in the office.  This is will also reduce the amount of time you spend in our office.

2 - HIPAA Privacy Notice

The Health Insurance Portability and Accountabiity Act (HIPAA) requires that we maintain the privacy of protected health information and to provide you 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 effecxts, we want every patient and their guardians to be aware of what to expecxt while in active treatment. 

For patients beginning active orthodontic treatment, we will require every patient and/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.

Mon8:00am to 5:00pm
Tue8:00am to 5:00pm
Thu8:00am to 5:00pm
Fri8:00am to 5:00pm