Patient Forms

New Patient Forms:

We are excited to welcome you in to our practice!  Please take a moment to complete our New Patient Information Form and HIPAA Privacy Consent Form prior to your first visit. (Please complete both forms)

New Patient Information Form
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HIPAA Privacy Consent Form
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Other helpful forms:

Retainer Options Form

(Review retainer information, review options for additional sets of retainers, and select your preference)

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For your convenience, we offer electronic and automatic payment options from a checking/savings account or through a debit/credit/FSA/HSA card. Download the appropriate form here:

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Trimmell Anders & White Orthodontics

  • East Location - 2143 N. Collective Ln., Suite A, Wichita, KS 67206 Phone: (316) 260-6566 Fax: (316) 260-9959
  • West Location - 3933 N. Maize Rd., Wichita, KS 67101 Phone: (316) 260-6566 Fax: (316) 260-9959