Patient Forms

Orthodontic Patient Forms

New Patient Forms

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When you come in for your first visit, we recommend that you fill out these forms ahead of time. This gives you time to find the information you need if it’s not readily available and verify its accuracy. If you have any questions, please don’t hesitate to call our office. These forms are generally used to go over best practices and patient information.

It’s an easy three step process to complete them: click on the form to start downloading the PDF, print the paperwork, and fill all areas out in the comfort of your own home.

Patient Form Information

By completing these documents in advance, we can expedite some of the processes associated with the first visit. The purpose of our patient forms is to communicate and inform you of your rights as a patient, while also making sure all necessary information is accessible during the initial appointment so we can provide the most effective care.

With these forms, you authorize that the information is given to the best of your knowledge and that you understand your responsibility as a patient. All information is private and protected. Our practice will not disclose confidential information without your consent or written authorization unless otherwise required by federal or state privacy laws.

You can read an overview of what is covered within each form below:

New Patient Registration 

  • Identifiable patient information
  • Emergency contacts
  • Insurance providers
  • Financial agreement
  • Medical and dental history

X-Ray Release Form

  • Consent to the release of personal X-rays
  • Preference for digital and/or hard copies

Practice Policies

  • Non-discrimination policies
  • Patient rights and responsibilities

HIPAA Communication Form

  • Provided notice of information and privacy practices
  • Preference for communications of health care information
  • Financial policy

Your First Appointment

When you come in for your visit, you’ll want to bring these four completed patient forms along with photo identification, insurance cards, and a method of payment for any copays or out-of-pocket costs due at time of service. It’s best to arrive ten minutes early to get settled before being called back for your appointment. For more information on what’s covered under insurance or the different financing options available to you, visit us here.

Questions Before You Come In?

The team at Precision Orthodontics is here to answer all of your questions. You can contact us by calling the number to the office nearest you. We’re conveniently located throughout Ohio near Cleveland, Youngstown, Toledo and Columbus. Find your local orthodontist office here and, if you still need to schedule an appointment, simply fill out this quick form.