Patient Forms


patient forms

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

  • Adolescent History Form PDF
  • Adult History Form PDF
  • HIPP Policy PDF
  • Dental Insurance Form PDF

Additional Treatment Information & Forms


  • Credit Card Authorization Form PDF
  • Checking/Savings Account Authorization Form PDF
  • Patient Release Form PDF


  • HIPAA Policy PDF
  • General Office Policy PDF
  • Office Hours/Appointment Policy PDF
  • Notice To Our Patients With Orthodontic Coverage PDF
  • Separator/Spacer Instructions PDF
  • Hyrax Expansion Instructions PDF
  • Caring For Your Smile With Braces PDF
  • Healthy Oral Habits PDF
  • Elastic/Rubber Band Wear PDF
  • Removable Appliance Instructions PDF
  • Positioner Instructions PDF
  • Retention Instructions For After Braces Removal PDF
  • Retainer Options PDF

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