We have several secure online forms available for use, please view the links below for examples. Once submitted, the information is emailed to you in a password-protected PDF document.
We also provide custom forms! If you would like to create a form that you don’t see here, reach out to your project manager so we can provide an estimate.
Health History Forms
Based on the AAO New Patient Health History form, these forms collect information about your new patients. These forms use conditional logic to show additional fields as needed to provide information about additional responsible parties or secondary insurance plans. These standard forms are complimentary with your website build, but a customized form based on your PDF is available for an additional fee.
- Orthodontic Health History Form for All Ages: https://secureonline.co/standard-new-patient-form/
- Dental Health History Form: https://secureonline.co/general-dentist-standard-new-patient-form/
- Pediatric Dental Health History Form: https://secureonline.co/standard-dental-new-patient-form-pediatric/
Informed Consent and Acknowledgement Forms
We continue to add additional forms as needed for our clients. Informed Consent forms are based on the AAO and Invisalign Informed Consent documents. The HIPPA Acknowledgement text can be replaced with text provided. Listed below are the current consent and acknowledgment forms available.
- Informed Consent for Orthodontic Treatment: https://secureonline.co/standard-informed-consent/
- Informed Consent for Invisalign Treatment: https://secureonline.co/standard-invisalign-informed-consent/
- HIPAA Acknowledgement: https://secureonline.co/hipaa-acknowledgement-example-form
- Social Media Consent Form: https://secureonline.co/standard-social-media-consent-form/
Patient Referral Forms
A convenient, secure platform for Dentists to refer their patients to your office. These forms allow for photos and/or x-rays to be sent along with patient information! This standard form is complimentary with your website build, and the checklist of reasons for the referral can be customized at no charge.
- Patient Referral Form: https://secureonline.co/standard-patient-referral-form/
Supplemental COVID Screening Forms
These forms were created based on the AAOIC forms introduced in 2020. The Consent is intended to be completed once per patient, while the Health Questionnaire would be completed prior to every appointment.
- COVID Supplemental Consent: https://secureonline.co/standard-aaoic-supplemental-consent/
- COVID Supplemental Health Questionnaire: https://secureonline.co/standard-aaoic-supplemental-questionnaire/
