Get the free ORTHODONTIC EXAMINATION REQUEST - Carlson Orthodontics

ORTHODONTIC EXAMINATION REQUEST Referring Doctor: Please call me about this patient. Date: Patient Name: Phone: Gender: Please call this patient to schedule. Male Female FM Bite wings Age: Available

How to fill out orthodontic examination request

How to fill out orthodontic examination request?

1. Start by obtaining the orthodontic examination request form. This can usually be obtained from your orthodontist's office or their website.
2. Read the instructions carefully to ensure that you understand what information is required and how to fill out the form correctly.
3. Begin by providing your personal information, such as your full name, date of birth, address, and contact information. This is important for the orthodontist to be able to reach you and keep accurate records.
4. Fill in your dental history. Include any previous orthodontic treatments you have had, any dental conditions or concerns you may have, and any medications you are currently taking.
5. Provide your current dental insurance information, if applicable. This will help the orthodontist to determine if your treatment may be covered by insurance and to estimate any potential costs.
6. If you have been referred by a dentist or another healthcare professional, make sure to include their information on the form.
7. Next, describe the reason for seeking orthodontic examination. Explain any specific concerns you have regarding your teeth or jaw alignment, and any symptoms or discomfort you may be experiencing.
8. If you have any dental X-rays or images, attach them to the examination request form as instructed. These can help the orthodontist to assess your condition more accurately.
9. Lastly, sign and date the form, indicating that all the information you have provided is accurate to the best of your knowledge.

Who needs an orthodontic examination request?

1. Individuals who are interested in orthodontic treatment for themselves or their children may need to fill out an orthodontic examination request. This request helps to initiate the process of evaluation and consultation with an orthodontist.
2. Dentists or other healthcare professionals may also need to fill out an orthodontic examination request for their patients. This is often done when they suspect that orthodontic treatment may be necessary to address specific dental issues.
3. Insurance companies may require an orthodontic examination request to determine if a patient's treatment is medically necessary and therefore eligible for coverage.
4. Schools or organizations that require proof of orthodontic treatment or need to provide referrals for their students or members may also need to fill out an orthodontic examination request.

In summary, anyone interested in seeking orthodontic treatment, dentists or healthcare professionals referring patients, insurance companies, and certain organizations may need to fill out an orthodontic examination request.

For pdfFiller’s FAQs

What is orthodontic examination request?

An orthodontic examination request is a form or document submitted to a dental professional to request an evaluation for orthodontic treatment.

Who is required to file orthodontic examination request?

Anyone who is seeking orthodontic treatment or a referral for orthodontic treatment is required to file an orthodontic examination request.

How to fill out orthodontic examination request?

To fill out an orthodontic examination request, you will need to provide personal information, dental history, insurance information, and reason for seeking orthodontic treatment.

What is the purpose of orthodontic examination request?

The purpose of an orthodontic examination request is to request an evaluation for orthodontic treatment or to obtain a referral to an orthodontic specialist.

What information must be reported on orthodontic examination request?

The information reported on an orthodontic examination request typically includes personal information, dental history, insurance information, and reason for seeking orthodontic treatment.

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