Questionnaires
After you have completed the Patient Registration Form:For an Orthodontic
Examination: Fill out our secure online Orthodontic Patient Health Questionnaire Form (by clicking the
button below). *You must use Internet Explorer or Mozilla Firefox to submit the Patient
Registration Form and the Questionnaire (Please do not use Google
Chrome).
After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Privacy Consent Form: Print and fill out Privacy Consent Form. Be sure to bring the signed form with you to your appointment.
After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Privacy Consent Form: Print and fill out Privacy Consent Form. Be sure to bring the signed form with you to your appointment.
For a TMJ Examination: Print and fill out the TMJ Questionnaire. Be sure to
bring the completed form with you to your TMJ examination appointment.
CLICK HERE TO REVIEW STEP BY STEP INSTRUCTIONS
PC Users
Our online form uses the latest Adobe Acrobat Reader plug-in to conveniently submit the form from home or work. Please download the free plug-in from Adobe's web site if it is not already installed on your system. It is important that you have at the latest version of the plug-in to successfully use our online form.
