Facebook
Instagram
Youtube
Fort Myers
1-239-936-1808
6300 Whiskey Creek Dr, Fort Myers, FL 33919
Cape Coral
1-239-458-2002
14 Del Prado Blvd N, Cape Coral, FL 33909
Home
Office
Meet Dr. Richards
Meet Our Staff
Office Policies
Map and Directions
Request Appointment
Fort Myers
Cape Coral
Rate Our Office Fort Myers
Rate Our Office Cape Coral
Services
Early Treatment
Adolescent Treatment & Braces
Adult Treatment & Braces
Invisalign
Invisalign For Teens
Elastics (Rubber Bands) In Orthodontic Treatment
Functional Appliances To Correct Bite Problems
Palatal Expanders
Temporary Anchorage Devices (Tads)
Thumb & Finger Appliances
Retention
Patient Information
Patient Forms
Financial and Insurance
Resource Videos
Technology
Blog
Contact Us
Fort Myers
Cape Coral
OrthoBanc Login
Menu
Menu
Patient Forms
Patient Forms
You may print and fill out the following form to assist us with your care.
Adult new patient medical history
Child new patient medical history
Notice of privacy practices
HIPPA compliance patient consent form
Scroll to top
Fort Myers
Cape Coral
×
Fort Myers
Cape Coral
×
