Patient Forms

New Patient Forms

Other helpful forms:

Retainer Options Form

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

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:

• Electronic Payment Authorization Form (Checking or Savings)*
• Automatic Payment Authorization (Credit, Debit, FSA, HSA)*

*These forms require Adobe Acrobat Reader. Click the Adobe logo to download.