Health History Form

Online new patient paperwork

Please take a couple of moments to complete our electronic Health History form prior to your initial consultation at Healdsburg Orthodontics. Prefer to print our form? Click here to download a copy of our Health History form, complete it at your convenience and bring it with you to your initial consultation/exam.

The Health History form below is broken into 5 sections, including Patient Information, Responsible Party, Dental Insurance, Medical History, and Authorization.