Fill out the applicable form to register as a patient.
New Patient Registration
Location
Aberdeen
Brookings
Milbank
Sioux Falls
Watertown
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.
Adult Orthodontic Treatment Consent
Complete this form to authorize us to provide various orthodontic treatments to you.
Child Orthodontic Treatment Consent
Complete this form to authorize us to provide various orthodontic treatments to your child.
Invisalign Orthodontic Treatment Consent
Complete this form to authorize us to provide various Invisalign 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 info@vanlaeckenorthodontics.com or mail the completed form to the corresponding office location.
