Get the free Orthodontic Patient Intake Form – Adult

This document is an intake form designed for adult patients seeking orthodontic treatment. It collects essential patient information, medical history, and insurance details to facilitate the orthodontic assessment process.

How to fill out orthodontic patient intake form

How to fill out orthodontic patient intake form

1. Start with the patient's personal information: Name, Date of Birth, Address, Phone Number, and Email.
2. Provide insurance information: Include the name of the insurance company, policy number, and group number.
3. Include medical history: List any medical conditions, allergies, and current medications.
4. Fill in dental history: Note previous orthodontic treatments, surgeries, and dental issues.
5. Answer questions about oral hygiene habits: Frequency of brushing, flossing, and dental check-ups.
6. Provide family history of orthodontic issues if applicable.
7. Include any specific concerns or goals related to orthodontic treatment.
8. Review the form for completeness and accuracy before submission.

Who needs orthodontic patient intake form?

1. Patients seeking orthodontic treatment.
2. Orthodontic clinics and practices to gather relevant patient information.
3. Insurance companies for processing claims and determining coverage.

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What is orthodontic patient intake form?

The orthodontic patient intake form is a document used by orthodontic practices to collect essential information from new patients. It typically includes details about the patient's medical history, dental health, and personal information.

Who is required to file orthodontic patient intake form?

New patients seeking orthodontic treatment are required to complete and submit the orthodontic patient intake form to the practice.

How to fill out orthodontic patient intake form?

To fill out the orthodontic patient intake form, patients should provide accurate personal information, including their full name, contact information, medical history, and any relevant dental history. It may be necessary to complete the form under the guidance of a dental professional.

What is the purpose of orthodontic patient intake form?

The purpose of the orthodontic patient intake form is to gather comprehensive information about the patient's dental and medical history, which assists orthodontists in planning effective treatment and ensuring patient safety.

What information must be reported on orthodontic patient intake form?

The information reported on the orthodontic patient intake form typically includes the patient's personal details, medical history, dental health information, insurance details, and any medications being taken.