Get Orthodontic Evaluation Form

Completing the Orthodontic Evaluation Form online is a straightforward process that helps streamline your orthodontic assessment. This guide will provide you with detailed instructions for each section of the form to ensure that you provide all necessary information accurately.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering the patient's name, age, and the date at the top of the form. This information will help identify the individual undergoing the evaluation.
3. Next, navigate to the Dental/Skeletal Classification section. Here, check the appropriate classification that applies: Class I, Class II (Div I or Div II), Class III, Bimaxillary Protrusion, or Skeletal Appearance.
4. In the Airway section, identify any relevant conditions by checking the corresponding boxes. Include information regarding a deviated septum, allergies, asthma, or other airway-related issues.
5. Proceed to the Dentition area, marking any instances of crowding on a scale from 1 to 5. This provides insight into the patient's dental alignment.
6. Fill out the Oral Conditions section, checking boxes for hygiene status, missing teeth, dental anomalies, active caries, and any habits like thumb sucking or tongue thrust swallowing.
7. For additional details, use the space provided under Other Conditions to describe any specific issues like TMJ discomfort or others that may impact orthodontic treatment.
8. Fill in the Cost of Treatment section accurately, detailing any fees associated with orthodontic records, special appliances, and the estimated total treatment fees.
9. Estimate the approximate treatment time by indicating the expected duration in months for both Phase I and Phase II if applicable.
10. Finally, review all entered information for accuracy before proceeding to save your changes. You can choose to download, print, or share the completed form as needed.

Start completing the Orthodontic Evaluation Form online today for a smooth orthodontic experience.