Patient Forms
Please help us be prepared for your first appointment by completing this Patient Information and Medical History form. Download the form below (in either Word DOC or Acrobat PDF format) to your computer, print it out, complete the form, and bring it with you to your first appointment.
Child Patient Information Form [Word DOC format]
Child Patient Information Form [Acrobat PDF format]
Adult Patient Information Form [Word DOC format]
Adult Patient Information Form [Acrobat PDF format]
Insurance Form [Word DOC format]
Insurance Form [Acrobat PDF format]
Personal Information Consent Form [Word DOC format]
Personal Information Consent Form [Acrobat PDF format]
Office Policies
Your First Visit
At the first visit the orthodontist will tell you if you or your child can benefit from orthodontic treatment, and if so, when treatment should start, how long it may be, and approximate fees related to treatment.
Your Second Visit
At the second visit, diagnostic records are made to determine the best course of treatment. Complete diagnostic records typically include plaster study models of the teeth, photos of the patient's face and teeth, and X-rays. This information is used to develop a custom treatment plan for each patient. These records are also helpful in tracking the progress of treatment as the teeth move under orthodontic care.
Consultation
After the doctor has evaluated your records, we discuss your treatment with you in detail, including the exact cost for your particular case.
Regular Appointments
The appointment when you get your appliances (braces, expanders, etc.) usually takes from one to two hours. You'll then see us every 10 weeks in the first 6 to 8 months, then at 8 weeks, and finally every 4 to 6 weeks in the last months of treatment. Patients are seen by appointment only. We make every effort to be on time for our patients, and ask that you extend the same courtesy to us. If you cannot keep an appointment, please notify us immediately. Cancel only if it is an emergency. It is difficult to reschedule you since most appointments are made 4 to 8 weeks in advance.
Payment & Office Policies
Cost
The cost of treatment depends on the severity of the patient's problem. You will be able to discuss fees and payment options before treatment begins. We offer monthly payment plans with no interest and no GST added to your fees. We do not accept assignment of insurance plans, but we will assist you with the forms and necessary information for your insurance. We work hard to make orthodontics affordable.
Fees
In an effort to keep orthodontic fees down while maintaining the highest level of professional care, we have established this financial policy:
- If full payment is made at the onset of treatment, we will offer 5% discount.
- To fit your individual needs, financial arrangements can be made to extend your payments over a period of months.
- For your convenience, we accept payment by VISA and MASTERCARD.
- In cases of serious delinquency, treatment will be discontinued, although we will make every effort to accommodate patients with temporary difficulties.
Insurance
Professional care is provided to you, our patient, and not to an insurance company. Thus, the insurance company is responsible to the patient and the patient is responsible to the doctor. We will help in every way we can in filing your claim and handling insurance questions from our office on your behalf.