Patient Forms

At Dr. McCoy Orthodontics, we know your time is valuable!

To help cut down on time spent in the office, we offer many of our patient forms online.  We will ask you via email or text to fill out specific forms and direct you here.  Only complete the forms that we request, using the blue links below.

We have a section for our Current Patients filling out required appointment health update forms prior to each appointment.

Below that we have a section for our Adult New Patients and a separate section for our Younger New Patients, as well.

Not every patient needs to complete all of the forms, so please save your time and only fill out the specific forms that we request via email or text, as we request them.

 

Current Patients Supplemental Consent and Health Questionnaire

As of May 13, 2020, all patients should complete our new Supplemental Consent form. This form only needs to be completed once.

Prior to every appointment, please complete our Supplemental Health Questionnaire form.  Please contact our office if you have any questions.

• Supplemental Health Questionnaire » PRIOR TO EVERY APPOINTMENT REQUIRED FORM

• Supplemental Consent » ONE TIME ONLY FORM

 

Forms for Adult New Patients

  1. Health History Form »
  2. HIPAA Acknowledgement »
  3. Written Authorization for Funds Withdrawal »
  4. Periodontist Referral Form »
  5. Informed Consent for Orthodontic Treatment »
  6. Informed Consent for Invisalign Patients »
  7. Informed Consent for Patients with an Impacted Tooth or Teeth »
  8. Informed Consent for Patients with Periodontal Concerns »

 

Forms for Younger New Patients

  1. Health History Form »
  2. HIPAA Acknowledgement »
  3. Written Authorization for Funds Withdrawal »
  4. Informed Consent for Orthodontic Treatment »
  5. Informed Consent for Invisalign Patients »
  6. Informed Consent for Patients with an Impacted Tooth or Teeth »