Fill out this form to register as a patient. A print-friendly form is available below.
Allows the use of photos showcasing your/your child's orthodontic success.
Keep your health/dental history up-to-date. Use this form to update your records.
Authorizes access to medical/orthodontic information and records.
Authorizes us to provide various orthodontic treatments to you or your child.
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
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.
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.
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.)
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.
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