Orthodontic Consultation Form Template
Collects a patient’s orthodontic concerns, treatment history, goals, contact details, and optional teeth photos for an orthodontic practice.
When to use it
- Before a new patient’s first orthodontic consultation
- When a parent or guardian is submitting details for a child
- To learn about previous braces or clear aligner treatment
- When patients want to share teeth photos before an appointment
What it asks
- Your name
- Your email address
- Your phone number
- Who is the patient?
- Patient’s name
- What orthodontic concerns would you like to discuss?
- Has the patient had braces or clear aligners before?
- If yes, please share any details you know
- What would you like to achieve with orthodontic treatment?
- Upload photos of the patient’s teeth, if available
Why it should be encrypted
Dental concerns, photos, and contact details are personal information. They should be readable only by the patient’s chosen orthodontic care team, not SealForm or unrelated people.
Tips
- Clarify which photo angles or formats are most helpful, and note that photos are optional.
- If a parent or guardian may complete the form, make the patient and submitter fields easy to tell apart.
- Add a note about how the practice will follow up and what patients should do for urgent concerns.