Orthodontic Patient Forms

 Please complete a copy of our Health History Form and bring it with you to your appointment.

Orthodontic Health History – Child

Orthodontic Health History – Adult

Privacy Statement HIPAA

Authorization to Accompany a Minor (If someone other than the patient’s legal guardian will be bringing them to their appointments)


If your child has been seen by another dentist or orthodontist and has a recent Panoramic X-ray, please contact that office and ask them to email a copy of the film to: info@durhampdo.com.

Orthodontic Patient Forms

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