Patient Forms & Deals


We have made our new patient forms available to you as adobe acrobat files. For your convenience, we recommend printing and completing these forms at home. Please remember to bring your completed forms with you to your first appointment. If you have a problem getting these files to print properly please call our office, and we will gladly send or fax them to you. Please complete all of the following forms:

  • Existing Patient Medical History Update (This form is accessed by clicking the New Patient Questionnaires link below and does not need to be printed. Then choose Med. Hist. Update(not for new patients) and fill in your responses. You will sign these electronic forms at the office.)
  • New Patient Questionnaires (These forms do not need to be printed. Simply fill in your responses. You will sign these electronic forms at the office.)
  • Notice of Privacy Practices (You may print these forms for your records only.)
  • Financial Policy (Please print and bring with you.)
  • Acknowledgement of Receipt of Notices of Privacy Policies (Please print and bring with you.)

 

Take advantage of our limited time offers!

Referrals from existing patients – Every New Patient will receive $75 off their first treatment at Ultra Smiles! Ask for details

Clear Correct – Receive $500 off of a comprehensive Clear Correct Braces case! Contact us today to see how ClearCorrect can help you!

Free Whitening For Life! – NEW PATIENTS – Free Whitening for Life! We would like to whiten your teeth and keep them white for life at no extra charge to you. Contact us for more information.

 

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