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VanLaecken Orthodontics
VanLaecken Orthodontics
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    • Home
    • Office Info
      • About Our Doctors
      • Meet Our Team
      • Blog
      • Locations
      • Schedule Appointment
      • Policies
      • Why Choose Us
      • Accessibility Policy
      • After-Hours
    • Patient Info
      • Office Visit
      • Patient Forms
      • Virtual Consultations
      • FAQ
      • Life With Braces
      • Before & After
      • Smile Gallery
      • Smile Rewards
      • After-Hours Contact
    • Treatment Info
      • When To Begin
      • Types of Braces
      • Invisalign
      • Invisalign Teen
      • Dental Monitoring
      • Retainers
      • Appliances
      • Laser Treatment
      • TMJ/TMD
      • Contact After-Hours
    • Contact
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Online Patient Forms

New Patient Registration

New Patient Registration

New Patient Registration

Fill out this form to register as a patient. A print-friendly form is available below. 

Fill Out Form

Photo Wavier

New Patient Registration

New Patient Registration

Allows the use of photos showcasing your/your child's orthodontic success.

Fill Out Form

AAOIC COVID Consent

New Patient Registration

Health History Update

Consent to receive orthodontic treatment during COVID-19 . A print-friendly form is available below. 

Fill Out Form

Health History Update

Medical/Financial Release

Health History Update

Keep your health/dental history up-to-date. Use this form to update your records.

Fill Out Form

Medical/Financial Release

Medical/Financial Release

Medical/Financial Release

Authorizes access to medical/orthodontic information and records.

Fill Out Form

Printable Patient Registration Form

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Please download the form below and complete all fields. Email the completed form to  info@vanlaeckenorthodontics.com or mail the completed form to the corresponding office location to register as a patient.

Aberdeen Office  |  631 S. Roosevelt St., Aberdeen, SD 57401  |  Phone: 605-226-3120
Watertown Office  |  600 4th St. N.E., Suite 103, Watertown, SD 57201  |  Phone: 605-882-1500
Milbank Office  |  102 W. 4th Ave., Suite 2, Milbank, SD 57252  |  Phone: 605-432-5011
Brookings Office  |  604 Medary Ave. S., Brookings, SD 57006  |  Phone: 605-692-7063

Download Patient Registration Form

DENTAL REWARDS CERTIFICATE

Please download the document below, and complete to be entered into a Smile Rewards Program prize drawing. Email the completed form to info@vanlaeckenorthodontics.com or mail the completed form to the corresponding office location.

Dental-Rewards-Certificate (pdf)Download

SUPPLEMENTAL INFORMED Consent Form

Download the document below, and complete to consent to receive orthodontic treatment during the COVID-19 era. Email the completed form to info@vanlaeckenorthodontics.com or mail the completed form to the corresponding office location. 

AAOIC Supplemental Informed Consent (pdf)Download

HIPAA Acknowledgement

Download the document below, and complete to acknowledge the HIPAA Privacy Act and VanLaecken Orthodontics' Privacy Notice. Email the completed form to info@vanlaeckenorthodontics.com or mail the completed form to the corresponding office location. 


You may also complete the digital form below to acknowledge our Privacy Notice.

HIPAA-Acknowledgement (pdf)Download

HIPAA Privacy Act Acknowledgement

I hereby acknowledge that I have received and reviewed a copy of VanLaecken Orthodontics Privacy Notice. (A copy is available for your viewing on our website.)

Read Privacy Notice

Please Complete this Form to Let Us Know You Have Received and Reviewed VanLaecken Orthodontics' Privacy Notice

You may refuse to sign this acknowledgement.

 ©  VanLaecken Orthodontics   |   info@vanlaeckenortho.com   |   Powered by Complete Media, Inc.


Aberdeen Office  |  631 S. Roosevelt St., Aberdeen, SD 57401  |  Phone: 605-226-3120

Brookings Office  |  604 Medary Ave. S., Brookings, SD 57006  |  Phone: 605-692-7063

Milbank Office  |  102 W. 4th Ave., Suite 2, Milbank, SD 57252  |  Phone: 605-432-5011

Sioux Falls Office | 4320 S. Minnesota Ave, Suite 102, Sioux Falls 57105 | Phone: 605-789-7000

Watertown Office  |  600 4th St. N.E., Suite 103, Watertown, SD 57201  |  Phone: 605-882-1500


VanLaecken Orthodontics is an orthodontist based in Eastern South Dakota. We provide the highest quality of orthodontic and temporal mandibular joint treatments including Invisalign. We are the most experienced Invisalign provider in South Dakota.

  • About Our Doctors
  • Meet Our Team
  • Blog
  • Locations
  • Schedule Appointment
  • Policies
  • Why Choose Us
  • Accessibility Policy
  • After-Hours
  • Office Visit
  • Patient Forms
  • Virtual Consultations
  • COVID-19 Statement
  • Consent Form
  • FAQ
  • Life With Braces
  • Before & After
  • Smile Gallery
  • Smile Rewards
  • After-Hours Contact
  • When To Begin
  • Types of Braces
  • Invisalign
  • Invisalign Teen
  • Dental Monitoring
  • Retainers
  • Appliances
  • Laser Treatment
  • TMJ/TMD
  • Contact After-Hours
  • Privacy Notice
  • Medicaid Patient Form
  • Contact

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