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 Covid-19 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.

 

Covid-19 Supplemental Consent and Health Questionnaire

 

All patients, including new patients, need to complete our new Supplemental Consent form. This form is in addition to your Health History form and only needs to be completed once.

Prior to every appointment, please complete our Supplemental Health Questionnaire form.

• Supplemental Health Questionnaire » REQUIRED PRIOR TO EVERY APPOINTMENT!

• Supplemental Consent » ONE TIME ONLY FORM AS A SUPPLEMENT TO HEALTH HISTORY.

Please email our office if you have any questions.

 

Forms for Adult New Patients

  1. Health History Form » and don’t forget the Supplemental Health Questionnaire above.
  2. HIPAA Acknowledgement »
  3. Informed Consent for Orthodontic Treatment »
  4. Informed Consent for Invisalign Patients »
  5. Written Authorization for Funds Withdrawal »
  6. Informed Consent for Patients with an Impacted Tooth or Teeth »
  7. Periodontist Referral Form »
  8. Informed Consent for Patients with Periodontal Concerns »

 

Forms for Younger New Patients

  1. Health History Form » and don’t forget the Supplemental Health Questionnaire above.
  2. HIPAA Acknowledgement »
  3. Informed Consent for Orthodontic Treatment »
  4. Informed Consent for Invisalign Patients »
  5. Written Authorization for Funds Withdrawal »
  6. Informed Consent for Patients with an Impacted Tooth or Teeth »