Patient Forms

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

Please take a minute to fill out the patient information form before your first appointment. Once you hit the submit button it will be sent to us.

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:

Dental Insurance Form

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

  • Insurance Form |

ACH Debit Form

Our office gives you the option to have payments automatically withdrawn from your checking account.

  • ACH Debit Form |

Credit Card Authorization Form

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

  • Credit Card Authorization Form |

No-No Foods List

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

  • No-No Foods List |