Six Locations:

Merritt Island
Palm Bay

Satellite Beach

Call: 321-914-3972

New Patient Forms

New patientsYour time is valuable and we do all we can to make your initial exam as convenient as possible. We have put together a new patient welcome packet that provides all necessary forms in a downloadable format.

It includes your health history questionnaire, orthodontic insurance questionnaire, HIPPA (privacy act), and other forms we ask that you fill out prior to your first visit.

Completing these forms at home will decrease in office waiting time and make getting your brilliant smile quicker and easier!

Simply click on the New Patient Packet link below, or the light blue downloadable forms tab to the right of the screen, fill out the documents and bring them to your complimentary initial exam.

The new patient packet includes all documents needed for you to fill out prior to your initial exam.

  • ftr-logo1

  • ftr-logo2

  • ftr-logo4

  • ftr-logo6

  • ftr-logo7

  • ftr-logo9

  • ftr-logo10

Our Locations

4531 N. Wickham Rd.
Suite A
Melbourne, Florida 32935
Merritt Island
455 Magnolia Avenue
Merritt Island, FL 32952
Palm Bay
580 Malabar Rd. SE
Suite 1A
Palm Bay, Florida 32907
Satellite Beach
1024 Highway A1A
Satellite Beach, FL 32937
1755 S Washington Ave
Titusville, FL 32780
1715 Berglund Ln
Unit 1
Viera, FL 32940