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
Health-Questionnaire2-COVID19-fillable-c[...]
Adobe Acrobat document [555.1 KB]
COVID-19 Supplemental Informed Consent Form
Supplemental-Informed-Consent-COVID19-fi[...]
Adobe Acrobat document [515.5 KB]

Call us at:

901-377-1744

 

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

Email:

info@memphisbraces.com

 

 

 



 

Use our contact form to get in touch.

 

 

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