New Patient Information
Here's where you will find all the necessary information you will need for your first visit with Dr. Pinzon or Dr. Weeden.
To be completed by either an adult new patient, or the parent or guardian of a minor new patient prior to the first visit. Bring this completed form to the New Patient Treatment Coordinator at your first appointment.
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully, print it out, sign and date it, and bring it with you for your first visit.
This form is optional under the new patient privacy regulations recently issued by the United State Department of Health and Human Services. We have elected to use this form. Prior to commencing your orthodontic treatment, you should review, sign, and date this form.
These forms are provided in Acrobat PDF Format. You can view these forms either in your computer's default PDF reader, or using Acrobat Reader. To obtain the free Acrobat Reader, follow this link, or click on the icon below.
