New Patient Health History Form
We would like to welcome you and your family to Mack and Hansen Orthodontics. In an effort to provide the best service possible we offer you the ability to complete the new patient paperwork online from your computer or phone. We ask you to fill out this form as completely as possible. Thank you so much and we look forward to seeing you soon!
Patient’s First Name
Patient’s Last Name
Best Phone #
Cell Phone Carrier (Allows us to send appointment reminders through text)
How do you prefer to receive appointment reminders?
Relatives treated at our office
How did you hear about our office?
My Dentist Referred Me
My Insurance Plan
If you heard about us from a friend, who was it?
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