Get Orthodontic Examination Form 2020-2025

Completing the Orthodontic Examination Form online is an essential step in ensuring your child's orthodontic needs are assessed accurately. This guide provides an easy-to-follow approach to filling out each section of the form, catering to varying levels of experience with online documentation.

Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the child's full name and nickname in the designated fields. Make sure to provide accurate spelling, as this information is vital for identification during appointments.
3. Fill in the child's birthdate, age, and sex. These details help the orthodontic team understand the child's development stage.
4. Provide the name of the school, along with the current grade. This information is relevant for maintaining records and facilitating coordination with parents.
5. Enter the home address, city, state, and zip code accurately to ensure proper communication regarding appointments and follow-ups.
6. Fill in the home number and email address for efficient contact. Ensure that these details are current and accessible.
7. Specify who the legal guardian is and provide their contact details, including full names, birthdates, addresses, and employment information for both parents.
8. Indicate the dental insurance details for both parents, including the contract number or Social Security Number, which will assist in processing insurance benefits.
9. Respond to questions about the child's participation in musical instruments, sports, and hobbies to give the orthodontist a more comprehensive understanding of the child's lifestyle.
10. Complete the health history section by providing the names and contact information for the child's dentist and physician. This includes any relevant health history such as past disorders, medications, and injuries.
11. Indicate any physical, emotional, or mental impairments your child may have and provide additional comments or information that will aid in the examination.
12. Fill in the 'Who referred you?' section to ensure the orthodontist has a record of how you learned about their services.
13. Provide an alternate emergency contact, including their name, relationship to the patient, and phone number.
14. Finally, authorize an orthodontic dental examination by signing and dating the form, and specify your relationship to the patient.
15. After thoroughly reviewing your entries for accuracy, you can save changes to the form, download it, print it, or share it as needed.

Complete your documents online now for a smooth orthodontic experience.