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.

• Demographic Information and Medical History Form  

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  

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Our office gives you the option to have payments automatically withdrawn from your checking account.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