NEW PATIENT FORMS

Thank you for choosing Shawano Orthodontics and trusting us to be a part of your overall dental health. Shawano Orthodontics strives to be the best in everything we do to help you achieve a healthy smile. We want your treatment to be a positive experience. We look forward to seeing you soon.

Before Your Free Initial Consultation

To allow us to spend as much time as possible with you during your first visit, we ask that you complete your patient forms on our secure online platform prior to your appointment.

After Your Free Initial Consultation

We are so excited you decided to start your journey to a healthy, beautiful and confident smile with Shawano Orthodontics. Your treatment coordinator will instruct you to complete one of the following form packets after your treatment plan is finalized.

At-home Instructions for Orthodontic Treatment

Download instruction packets that apply to your treatment. 

ADDITIONAL 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. Siu 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 badminton? 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.