Hello Patient and/or Parents,
In order to limit the amount of paperwork that we are passing back and forth, we would greatly appreciate you filling out the electronic forms that are linked below before your appointment. The first form is a screening to make sure that we are not seeing anyone that could potentially be sick. The second form is an informed consent. Please make sure to fill out BOTH forms, using the patient’s name. We also would like to remind you to wear a mask to your appointment. Thank you for your compliance to make our office as safe as possible.
Sincerely,
Dr. Helms & Image Orthodontics Team
Notice of Privacy Practices under HIPAA
For those who would like to print and fill out the health history form by hand, you may download the form.
