Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

Patient Medical History Form

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

Patient Medical History Form
pat. info.doc
Microsoft Word document [58.5 KB]
Formulario de historial médico del paciente
pat info spanish.doc
Microsoft Word document [65.5 KB]
COVID-19 Prescreening Health Form
Adobe Acrobat document [555.1 KB]
COVID-19 Supplemental Informed Consent Form
Adobe Acrobat document [515.5 KB]

Call us at:



The Orthodontic Clinic, P.C.


Bartlett Location:


6637 Summer Knoll Circle, Suite 102

Bartlett, TN 38134


East Memphis Location:


1713 Kirby Parkway

Memphis, TN 38120


Fax:  901 507 4772






Use our contact form to get in touch.



Print | Sitemap
© The Orthodontic Clinic, P.C.