Follow the steps to fill out the patient form with ease.

1. Click ‘Get Form’ button to retrieve the patient form and open it for filling out.
2. Begin with the patient information section. Enter the patient's full name, preferred nickname, gender, age, birth date, social security number, and contact email. Ensure all information is accurate before proceeding.
3. Complete the address section by providing the patient's home address, including city, state, and zip code. Fill in the home, cell, and work phone numbers as applicable.
4. In the family dentist portion, indicate the name of the patient's dentist, the date of the last cleaning, and whether any dental work is pending, including a brief description if applicable.
5. Provide referral information, noting how the patient learned about Ferris Orthodontics, and fill out the patient's school, grade, and hobbies or sports.
6. In the siblings or children information section, provide the names, genders, and birth dates of the patient's siblings or children as necessary.
7. Next, fill out the responsible party information. Enter the full name, marital status, address, contact numbers, and social security number of the responsible party, along with their relationship to the patient.
8. Complete the dental insurance information section, including the insured's name, member ID, insurance company, and contact numbers. If applicable, fill in details for dual coverage.
9. Designate a person to release patient information to, providing their name, contact numbers, and their relationship to the patient.
10. Fill out the health questionnaire fully, noting any concerns regarding dental health, current medications, and any medical conditions the patient may have.
11. Finally, read and sign the authorization section. Confirm that all information provided is accurate and agree to the terms as outlined. Note the signature of the person filling out the form and the date.
12. After reviewing the completed form for accuracy, you can save any changes, download, print, or share the form as needed.

Start filling out the Ferris Orthodontics Patient Form online today to ensure a smooth orthodontic experience.