Address

115 Alpine Ct, Shawano, WI 54166, USA

Contact

Toll Free: (866) 526-2544

(715) 526-2544

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© 2018 BY SHAWANO ORTHODONTICS. ALL RIGHTS RESERVED.

FORMS

ACQUAINTANCE FORM - CHILD

For adolescent patients, parents/guardians please take a moment to download, print and fill out completely the Acquaintance Form. Please bring this form with you to the first appointment. This form gives us an overview of the patient’s dental and medical history.

ACQUAINTANCE FORM - ADULT

For adult patients, please take a moment to download, print and fill out completely the Adult Acquaintance Form. Please bring this form with you to the first appointment. This form gives us an overview of your dental and medical history.

WELCOME! INTERESTS FORM

Dr. Swetlik loves to get to know his patients! He has shared some of his favorite interests on the Welcome! Interests form. Did you know he loves Spaghetti? Kids if you could take a moment to fill out this form with some of your hobbies, favorite foods, sports you like to play and any other interests, that’d be great! Bring it with you to your first appointment. We look forward to getting to know you!

PRIMARY INSURANCE

This form is used to verify Orthodontic Coverage with your Primary Insurance Carrier. Please complete the Primary Insurance Coverage Section, Employer Information Section and the Subscriber Information Section. You will also need to bring your current Dental Insurance Card to the initial appointment.

SECONDARY INSURANCE

This form is used to verify Orthodontic Coverage with your Secondary Insurance Carrier. Please complete the Secondary Insurance Coverage Section, Employer Information Section and the Subscriber Information Section. You will also need to bring your current Dental Insurance Card to the initial appointment.