Patient Forms Patient Forms Please complete the applicable Medical history, HIPPA, and Photo Release forms. Please bring these forms to your first appointment. New Patient Information Form (English) New Patient Information Form (Spanish) HIPPA – Notice of Privacy Practices (English) HIPPA – Notice of Privacy Practices (Spanish) Informed Consent for Orthodontic Patient Dental Visit Voucher Photo Release Form (English) Photo Release Form (Spanish) 903 Jordan Blass Dr., Suite 102, Melbourne, FL 32940 PHONE: 321.425.5050 FAX: 321.428.3842 Get Directions
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