Get the free GENERAL ORTHO INTAKE FORM - STREAMLINE VERSION 1-24-17.docx

HISTORY FORM General Or tho Patient Name: Date of Birth: Individual Completing form: Patient Parent Caregiver StaffWhat are you being seen for today? Vitals:Height: ft/ inchesWeight: lessor Nursing

How to fill out general ortho intake form

How to fill out general ortho intake form

1. Start by writing your personal information such as your name, address, and contact details.
2. Fill in your medical history, including any past surgeries, medications you are currently taking, and any relevant health conditions.
3. Provide information about your dental history, such as previous orthodontic treatments, braces, or dental appliances you have used before.
4. Mention any specific concerns or problems you are experiencing with your teeth or jaw.
5. Answer questions related to your oral habits, like thumb sucking or teeth grinding.
6. Include any allergies or sensitivities you may have to certain materials or medications.
7. Indicate whether you have dental insurance and provide details if applicable.
8. Sign and date the form to certify the accuracy of the information provided.

Who needs general ortho intake form?

1. General ortho intake forms are required for anyone seeking orthodontic treatment. This includes individuals of all ages who wish to improve their dental alignment, correct bite issues, or address other orthodontic concerns.

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What is general ortho intake form?

The general ortho intake form is a document used to collect essential information about a patient's dental and orthodontic history, health status, and treatment preferences prior to their first appointment with an orthodontist.

Who is required to file general ortho intake form?

Typically, all new patients seeking orthodontic treatment are required to fill out the general ortho intake form to ensure that the orthodontist has complete information for effective diagnosis and treatment planning.

How to fill out general ortho intake form?

To fill out the general ortho intake form, patients should provide accurate personal information, dental and medical history, current medications, any allergies, and specific concerns or goals regarding their orthodontic treatment.

What is the purpose of general ortho intake form?

The purpose of the general ortho intake form is to gather comprehensive information that helps the orthodontist assess the patient's needs, plan appropriate treatment, and ensure safety and efficacy in the orthodontic process.

What information must be reported on general ortho intake form?

The information that must be reported on the general ortho intake form includes patient demographics, dental history, medical history, allergies, current medications, and any concerns about dental health or past treatments.