New Patient Forms
Completing your patient form before your first appointment saves time at the visit and lets us check your insurance benefits in advance, so we can tell you what your plan is likely to cover during the consultation rather than afterwards.
Download the form that applies, complete it, and return it to us before your visit. If you have not booked an appointment yet, start there. If it is easier, bring it with you instead.
If you’re unable to open PDF files, you can get Adobe Reader® for free.
What the form asks for
Nothing surprising, and nothing you will need to research. It covers who the patient is and how to reach you, your dental and medical history, any medications and allergies, whether the patient has been told to pre-medicate before dental work, who your general dentist is, and your dental insurance details.
For a child, a parent or guardian completes it and signs the consent section. If anything on the form does not apply to you, leave it blank and we will go through it at the appointment.
What else to bring
Your insurance card, any recent X-rays or records from your general dentist, and a treatment plan from another orthodontist if you are coming for a second opinion. Everything else is covered on the first visit page.
Questions before you come in
Call (631) 265-3666 and someone will walk you through the form, or bring it in blank and we will fill it in together. Nobody has ever been turned away for arriving without paperwork, and it is not worth putting off an appointment over. Dr. Shank and the team look forward to meeting you.
Smithtown Orthodontics 200 E Main St. Smithtown, NY 11787 (631) 265-3666
