Please allow approximately 10 minutes to fill out the new patient paperwork.
In order to best diagnose orthodontic treatment, there are three initial records we need to take. These records include intraoral photographs (taken with a digital camera), a panoramic x-ray that shows all the teeth in the mouth on one film, and a cephalometric x-ray that shows a side profile so the doctor can evaluate the patient's jaw position. These records will be taken at no charge during your consultation appointment.
For the patient's safety, we use low-radiation x-ray technology and will only take these radiographs if we do not have recent images on file. No photographs or x-rays will be used for any reason other than diagnostic purposes.
I have read and understand the above information and give Kids Care Dental & Orthodontics permission to take photographs and x-rays.
Signature below is acknowledgement that you have read and understand the HIPAA Notice of Privacy Practices.