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Orthodontics and Pediatric Dentistry

Dental Treatment Forms

Please print and fill out the required forms and bring them with you to your appointment.  Thank you for your cooperation.


All Pediatric and Orthodontic Patients


Pediatric Patients

Pediatric patients also need to complete the standard health questionnaire. 

If you answer "YES" to question #7 on the health questionnaire, you will need to fill out the supplemental questionnaire.

If someone other than a parent or legal guardian is bringing the pediatric patient, the temporary delegation form must be filled out and brought to the appointment in order for the child to be seen.