New Patient Forms

New Patient Forms2024-05-09T17:40:06+00:00

New Patient Forms

New Patient Forms

We are excited that you are considering starting your orthodontic journey with us, and we can not wait to meet you at your upcoming visit! At Jay Harris Orthodontics, we are committed to providing you with the best possible care in a timely and efficient manner. In an effort to expedite the paperwork at your first visit, we have compiled the new patient form for you below.

Please complete the following new patient form before you arrive at your appointment so that we can ensure your visit is as efficient and valuable as possible.

New Patient Forms:

Additional Items:

In addition to your filled new patient form, please be sure to bring the following documents with you to your first visit:

  • Have you had a Panorex X-ray taken within the last 6 months? If yes, please bring a copy with you to your appointment or have your dentist email us a copy at our email address,
  • Do you have orthodontic insurance? If yes, bring your insurance card so we can provide a cost estimate.

As always, please feel free to contact our office if you have any questions before your appointment. We are excited to see you and welcome you to our family!

Contact Us

(706) 324-5627 |
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