Medical History Form

Medical history form – Child

The medical forms for Children are for those ages 0-17 years old. These forms are to be completed by the child’s parent or guardian and include consent for treatment. If you are under Medicaid insurance, please have a referral from your general dentist, with all needed treatment of cavities completed prior to our initial consult

Medical history form – Adult

Our medical forms for Adults should be completed by anyone 18 years of age or older. If you have not had a dental appointment with your regular dentist in the last year, we request that you complete a general dental exam and cleaning prior to your initial orthodontic consultation.

If you are unable to read or speak English, we do have Spanish-speaking interpreters available at the office to assist you with the forms.