Get Under 18-child New Patient Information Form - Macomb Orthodontics

Filling out the Under 18-Child New Patient Information Form for MacOmb Orthodontics online is a straightforward process that ensures the orthodontic team has the necessary information to provide the best care for your child. This guide will walk you through each section of the form, offering clear instructions to help you complete it smoothly.

Follow the steps to successfully fill out the form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering the patient information, including the patient's last name, first name, birthdate, age, social security number, and contact details such as address, home phone, cell phone, and email.
3. If the patient is a minor, provide the name of the parent or guardian. Then, input the name of an emergency contact person along with their phone number.
4. Fill in the patient's school information, including the name of the school, grade, and any musical instruments played or sports/hobbies enjoyed.
5. List any siblings’ names and ages, as well as other family members who have been treated at the practice. Additionally, provide the name of the patient's dentist and how you heard about MacOmb Orthodontics.
6. Proceed to the responsible party information section. Enter the responsible party's name, marital status, contact information, and employment details.
7. Next, fill out the insurance information for the primary insurance policy holder, including their name, social security number, birthdate, and details about the insurance company.
8. If applicable, complete the secondary insurance information by providing the same details as required for the primary insurance.
9. In the general health history section, provide information about the patient's physician, any relevant health indicators such as height and weight, and answer questions regarding puberty and general health.
10. Complete the medical history questions, including any past major health issues, and additional health information required by the orthodontic practice.
11. The dental history section requires information about the patient's last dental visit, any prior orthodontic treatments, and their oral health practices.
12. Finally, review the authorizations section. Sign the form as the patient (if over 18) or as the parent or legal guardian. Make sure to double-check all information for accuracy.
13. Once all sections are completed, save your changes, and choose whether to download, print, or share the form as needed.

Complete the Under 18-Child New Patient Information Form online today to get started on your orthodontic journey!