Jennifer Stachel Orthodontics Forms

Patient Forms

New patients are welcome to complete their registration prior to your visit using our secure online Registration Form. Once the form has been completed, please be sure to press the Submit button to automatically send us your information. Please be assured that every precaution has been taken to ensure that our patients’ private health information remains secure.

For your convenience, click on the links below to complete our patient forms.

Online Patient Medical Forms

Under 18 Medical History
Adult Medical History

Paper Forms

Health History
Signature On File

COVID Intake Form

COVID Intake Form