ortho-intake-01

Orthodontic New Patient Intake – Child

This new patient intake form for orthodontic clinics collects information about adolescent patients. It includes boxes asking for basic patient contact information, their dental information, medical history, their parent/guardian information, and their permission and signature. Additionally, patients are asked to list the date of their last dental check-up and cleaning, as well as the primary reason for their visit that day.

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