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Patient Forms

Demographic Information and Medical History Form (for New Patients only)

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

  • Demographic Information and Medical History Form (Child) DOC
  • Demographic Information and Medical History Form (Adult) DOC

Annual Medical Update Form (for current patients only)

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

  • Annual Medical Update DOC

Dental Insurance Form

Please fill out our Insurance form and bring it with you to your first visit.

  • Insurance Form DOC

ACH Debit Form

Our office gives you the option to have payments automatically withdrawn from your checking or savings account.

  • ACH Debit Form DOC

Credit Card Authorization Form

Our office gives you the option to have payments automatically charged to your credit card.

  • Credit Card Authorization Form  DOC

No-No Foods List

Print out our list of foods we recommend you stay away from while wearing braces.

  • No-No Foods List DOC
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