Patient Forms
My Life. My Smile.
Please be prepared for your first appointment by completing this Patient Information Form.
Download the form below to your computer, print it out, complete the form, and bring it with you to your first appointment.
Consultation and Treatment Analysis
The cost of your orthodontic treatment may vary depending on your individual needs and treatment plan. Our staff will discuss with you the cost of your treatment, and each of your available payment plan options, so that you are able to make the best choice for you and your smile. We will work with you to create a payment plan that fits your budget and you will know what to expect before beginning treatment. Normally, Dr. Larson or Dr. Holland can provide a cost for treatment at your initial exam.
Affordable Payment Options
Financial Information
The cost of your orthodontic treatment may vary depending on your individual needs and treatment plan. We will work with you to create a payment plan that fits your budget and you will know what to expect before beginning treatment.
Affordable Payment Plans
Your smile is yours forever, and we want to make it as easy as possible for you to receive the best care whenever you need it.
Our practice accepts most major credit cards and insurance plans, and we offer affordable third-party financing options
Insurance Accepted
Our office staff is available to help to electronically file your claims with your insurance company. We’ll work with your insurance provider and make sure you understand your insurance benefits. Please let us know if you have any questions about your insurance coverage; and let us know how we can help to make your entire dental experience a pleasant one.
Schedule Your Consultation
Fill out the form below and we will contact you during our working hours.
