Get the free Orthodontic Acquaintance Form - The Big Smile Orthodontics

Orthodontic Acquaintance Form Patient Information Male FemaleFirst Name:Last Name:Preferred name:Birth date: If referred, by whom? Special sports or hobbies:Schooler family members and their birthdates: Please

How to fill out orthodontic acquaintance form

How to fill out orthodontic acquaintance form

1. Step 1: Start by entering your personal information such as name, date of birth, and contact details.
2. Step 2: Provide your dental history, including any previous orthodontic treatment you may have received.
3. Step 3: Fill out the medical history section, detailing any allergies, medications, or health conditions you have.
4. Step 4: Indicate the reason for your orthodontic visit and any specific concerns you have about your teeth or jaw.
5. Step 5: Answer the questionnaire about your oral habits, such as thumb-sucking, teeth grinding, or mouth breathing.
6. Step 6: If applicable, provide information about your dental insurance or payment preferences.
7. Step 7: Review the form for accuracy and completeness before submitting it to the orthodontic office.

Who needs orthodontic acquaintance form?

1. Anyone seeking orthodontic treatment or consultation needs to fill out the orthodontic acquaintance form.
2. This form is usually required for new patients, as it helps the orthodontist understand the patient's dental and medical history.
3. Patients of all ages, including children, teenagers, and adults, may need to complete this form.

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What is orthodontic acquaintance form?

Orthodontic acquaintance form is a document used to gather information about a patient's orthodontic history and treatment.

Who is required to file orthodontic acquaintance form?

Orthodontic professionals such as orthodontists, dentists, and orthodontic assistants are required to file the orthodontic acquaintance form.

How to fill out orthodontic acquaintance form?

To fill out the orthodontic acquaintance form, one must provide detailed information about the patient's orthodontic treatment, history, and any relevant medical conditions.

What is the purpose of orthodontic acquaintance form?

The purpose of the orthodontic acquaintance form is to ensure that orthodontic professionals have all the necessary information about the patient's orthodontic treatment history before proceeding with any further treatment.

What information must be reported on orthodontic acquaintance form?

The orthodontic acquaintance form must include details about the patient's previous orthodontic treatments, current orthodontic needs, any relevant medical conditions, and contact information.