Patient forms

Choose the right new-patient form

Adults and children use separate secure intake forms. Pick the one that matches the patient, then complete it online before your visit.

Adult form Child form

Secure Jotforms

Complete forms online

These forms open in embedded Jotform frames and include direct fallback buttons.

Adult new-patient form

For adult patients

Use this form if the patient is an adult beginning orthodontic care with Orbach Orthodontics.

Open adult form

Child new-patient form

For children and younger patients

Use this form when a parent or guardian is completing intake information for a child.

Open child form

Ready to get started?

Book your free consultation

Once your new-patient forms are complete, the next step is your visit. Haven't booked yet? Request a free consultation with Dr. Orbach — no referral needed, at either our Washington, DC or Alexandria, VA office.

Free Consult