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Signature Date // Our office is committed to meeting or exceeding the standards of infection control mandated by OSHA the CDC and the ADA. Address Insurance Co. Phone Group Policy Owner s Name Relation Policy Owner s Birthdate // Policy Owner s SS Secondary Orthodontic Insurance What are the main concerns that you would like orthodontics to accomplish Has your child ever been evaluated for or had orthodontic treatment before Have there been any injuries to the face mouth teeth or chin Have...
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Start by providing your personal information such as your name, address, and contact details.
02
Proceed to fill out the medical history section, be thorough and honest about any conditions or allergies you may have.
03
Next, provide your dental history including any previous orthodontic treatment or surgeries.
04
Specify the reason for your visit and any specific concerns you may have.
05
If you have dental insurance, provide the necessary information and bring your insurance card for verification.
06
Review all the information you have entered to ensure accuracy and completeness.
07
Finally, sign and date the welcome form to confirm that the information provided is true and accurate.

Who needs welcome to form orthodontist?

01
Anyone who is visiting an orthodontist for the first time and needs to provide their basic personal and medical information.
02
Individuals who have had previous orthodontic treatment but are visiting a new orthodontist and need to fill out a welcome form.
03
Patients with specific dental concerns or conditions that require orthodontic attention and treatment.
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Welcome to form orthodontist is a form that welcomes new patients to the orthodontist's practice and gathers necessary information.
New patients visiting an orthodontist's practice are required to fill out the welcome to form.
Patients can fill out the welcome to form at the orthodontist's office by providing personal and insurance information.
The purpose of the welcome to form orthodontist is to collect patient information and establish a record for future appointments.
Information such as patient's name, contact details, insurance information, medical history, and reason for visit must be reported on the welcome to form orthodontist.
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