Patient Registration Forms

Please Download and Fill Out the form(s) below. We know your time is valuable. Filling out the form will help us expedite the process when you come into the office for your appointment or consultation.

***Adobe reader required to open PDF files. If you do not have Adobe reader installed, click here to download it for free.

Please follow these instructions to fill in the Child or Adult form and bring it to our office.

  1. Click either the icon or the link to download the form to your computer.
  2. Open the form using Adobe Reader. (See link above if you need to download Adobe Reader)
  3. Fill in the form.
  4. Click the “Print Form” button in the upper right side of the form to print it out the form.
  5. Bring the form with you when you visit our office.

FOR PATIENTS UNDER 18:

Child Registration Form (PDF)
(Please follow instructions above to fill in form and bring it to our office.)


FOR ADULT PATIENTS:

Adult Registration Form (PDF)
(Please follow instructions above to fill in form and bring it to our office.)


INSURANCE INQUIRY:

Insurance Form (PDF)
(Please follow instructions above to fill in form and bring it to our office.)

***Adobe reader required to open PDF files. If you do not have Adobe reader installed, click here to download it for free.

McIntosh Orthodontics takes a conservative approach and assures that we only do what's best for you as our patient. Our team and dedication to on-going education is our commitment to you and your family. Call Us Today for a Free Consultation at (407) 644-8786