Corpus Christi Forms - SmileLife Orthodontics

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Forms & Documents

Corpus Christi Forms

These forms are to be used internally by Treatment Coordinators in Corpus Christi.

Patient Forms

Full New Patient Packet

^{(Contains Health History, NPP, HIPAA, Photo Release)}

Health History Form

HIPAA Acknowledgement

Model Release Form

Notice of Privacy Practices

Financial Forms

Invisalign Financial Agreement

Patient Treatment Quote

Processing Authorization – ACH Transfer

Processing Authorization – Credit/Debit

Whitening Financial Agreement

Consent, Instruction, & Qualification Forms

Informed Consent Statement

Phase 1 Orthodontic Consent

Zoom Whitening Consent

Zoom Whitening Post-Treatment Instructions

Zoom Whitening Qualifications