Surgery Forms

Orange Smiles

Below you will find the necessary patient intake forms that will need to be completed in order for your clinic to confirm your appointment. These forms are HIPPA compliant and will be securely sent directly to the office for the doctors review. The Patient Intake Forms will be the only forms necessary for submitting. The Pre-Op and Post-Op Instructions are there for review. Please follow all Pre-Op Instructions, including when to stop eating and drinking, as well as designated driver information. Please complete these to the best of your ability making sure to input all medical history, allergies, and medications. Please read though our privacy disclosure HERE and feel free to contact the office with any further questions at 409-204-0077.