RX Smile

Patient Forms

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Please take a minute to print and fill out the patient information form before your first orthodontic appointment:

» Patient Form [PDF]
» Child Questionnaire [PDF]
» HIPPA Patient Consent Form [PDF]
» Parent/Guardian Permission for Treatment Form [DOC]

If you're unable to open PDF files, you can get Adobe ReaderĀ® for free.

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214-503-0060 | 8510 Abrams Suite 508 Dallas, TX 75243

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