Get the free Orthodontic Screening Form

This form is used by Pacifica Dental for conducting orthodontic screenings, documenting patient information, treatment discussions, price and time estimates, and recording patient or parent responses.

How to fill out orthodontic screening form

How to fill out orthodontic screening form

1. Obtain the orthodontic screening form from your orthodontist's office or their website.
2. Fill in your personal information at the top, including your name, date of birth, and contact information.
3. Provide details about your dental history, including any previous orthodontic treatments and dental issues.
4. Indicate any current dental concerns, such as pain or misalignment.
5. Complete the sections about your medical history, noting any conditions that may affect treatment.
6. List any medications you are currently taking.
7. Include information about your family's dental health history if requested.
8. Review the form for completeness and accuracy before submitting it.

Who needs orthodontic screening form?

1. Individuals experiencing dental alignment issues.
2. Parents looking to assess the orthodontic needs of their children.
3. Adults considering orthodontic treatment for aesthetic or functional reasons.
4. Patients with a history of dental problems or those who have had previous orthodontic care.

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What is orthodontic screening form?

An orthodontic screening form is a document used by dental professionals to assess a patient's need for orthodontic treatment. It collects relevant information about the patient's dental health and alignment.

Who is required to file orthodontic screening form?

Typically, dental practitioners, orthodontists, or dental clinics that are seeking to provide orthodontic services for patients are required to file this form.

How to fill out orthodontic screening form?

To fill out an orthodontic screening form, patients or dental professionals must provide personal information, medical history, dental history, and details regarding the patient's current dental condition. It may also require signatures and consent.

What is the purpose of orthodontic screening form?

The purpose of the orthodontic screening form is to evaluate the need for orthodontic treatment and ensure that the patient's dental issues are properly identified and documented.

What information must be reported on orthodontic screening form?

Information that must be reported includes patient demographics, medical history, dental history, specific dental issues, and any prior orthodontic treatments.