General Anesthesia
PEDIATRICIAN FORMS
Please complete this form to request a School Dental Certificate for school registration. Use a separate form for each child. We will email you
a certificate promptly.
Myofunctional Clinic
Here you can complete our Myofunctional clinic documents, such as digital forms, agreements and other important files:
Active Wound Management Consent (Infant)
Frenectomy Surgery Consent (Infant & Child)
General Anesthesia Facility Charge (Short Case)
Pre-Anesthetic Instructions for General Anesthesia
Consent for Oral Surgery under General Anesthesia
Pediatric Medical Questionnaire
Home Care Instructions After Surgery under General Anesthesia
Post Op Info
Here you can complete our Myofunctional clinic documents, such as digital forms, agreements and other important files:
Please complete this form to request orthodontic clearance. Use a separate form for each child. Please allow 48 hours for a completed form. You will need to enter your child’s information before accessing the form to ensure our software matches the form with your child’s digital file
Please complete this form to request orthodontic clearance. Use a separate form for each child. Please allow 48 hours for a completed form. You will need to enter your child’s information before accessing the form to ensure our software matches the form with your child’s digital file
Request Orthodontic Clearance
Please complete this form to request orthodontic clearance. Use a separate form for each child. Please allow 48 hours for a completed form. You will need to enter your child’s information before accessing the form to ensure our software matches the form with your child’s digital file
Request School Dental Certificate
Please complete this form to request a School Dental Certificate for school registration. Use a separate form for each child. We will email you
a certificate promptly.
Request Dental Records
Please complete this form to request Dental Records. Use a separate form for each child. Please note that x-rays will be forwarded via email and allow 48 hours for our response. You will need to enter your child’s information before accessing the form to ensure our software matches the form with your child’s digital file.
Request Orthodontic Clearance
Please complete this form to request orthodontic clearance. Use a separate form for each child. Please allow 48 hours for a completed form. You will need to enter your child’s information before accessing the form to ensure our software matches the form with your child’s digital file
Request FSA / HSA Receipt
Please complete this form to request an FSA/HSA receipt. Please allow 24 hours for your request to be completed.
Request Prescription Refill
Please complete this form to request a prescription refill. Please allow 24 hours for your request to be completed.