Patient Forms

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New Patient Registration

Fill out the applicable form to register as a patient.

Location

Aberdeen

Adult / Child

Brookings

Adult / Child

Milbank

Adult / Child

Sioux Falls

Adult / Child

Watertown

Adult / Child

Photo Waiver

Complete this form to allow the use of photos showcasing your/your child’s orthodontic success.

Health History Update

Complete this form to update your records and keep your health/dental history up-to-date.

Medical/Financial Release

Complete this form to authorize access to medical/orthodontic information and records.

Orthodontic Treatment Consent

Complete this form to authorize us to provide various orthodontic treatments to you or your child.

Dental Awards Certificate

Please download and complete this document to be entered into a Smile Rewards Program prize drawing. Email the completed form to [email protected] or mail the completed form to the corresponding office location.