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  • Health History Form

  • Submit Your Health History Form Online to Your Orthodontist

    Save time and fill out your registration and health history information online! Fill out this confidential form, click the "Submit Form" button at the bottom, and your information will be sent to our office with secure encryption.
    We will have your information when you arrive for your first appointment. You will need to provide a signature at the office to verify that the information you submitted online is accurate.

  • Welcome to OX!

    Patient Information
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  • Dental Insurance Information

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  • I have a second dental plan

    If you have second dental plan, please fill this fields
  • Responsible Party Information

    If patient is under 18, please complete this section.
  • Dental History

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  • KIDS SECTION

  • By clicking the "Submit Form" button below, you certify that the above information is correct and accurate to the best of your knowledge. All information is confidential and is accessed only via a secure, encrypted interface.

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