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To save time at your initial consultation please complete the required New Patient Medical Form.

New Patient Medical Form

Please complete and click submit when done.

New Patient Form
Please provide a different contact number and name than above.
Please list any known allergies.
If none, please write No Healthfund.
Example: 1234 56789 01 05/2023
Example: Dr Tooth at ABC Dental.
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Please select as many as apply.
Preferred Practice Location
If orthodontic treatment is deemed necessary, how soon would you like to get started?