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    List any medication, nutritional supplements, herbal medications or non-prescription medicines, including fluoride supplements that you take.

  • FAMILY MEDICAL HISTORY

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  • RELEASE AND WAIVER

    I authorize release of any information regarding my orthodontic treatment to my dental and/or medical insurance company.

  • I have read the above questions and understand them. I will not hold my orthodontist or any member of his/her staff responsible for any errors or omissions that I have made in the completion of this form. I will notify my orthodontist of any changes in my medical or dental health.

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  • Mobile

    58 Mobile St
    Mobile, AL 36607

      (251) 479-9597

  • Mobile

    801 S University Blvd Building B-2
    Mobile, AL 36609

      (251) 479-9597

  • Mobile

    1059 Snow Road South, Building A,
    Mobile, AL 36695

      (251) 479-9597

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Our Locations

801 S University Blvd. Building B-2
Mobile, AL
(251) 479-9597
___

58 Mobile St
Mobile, AL
(251) 479-9597
___

1059 Snow Road South, Building A
Mobile, AL
(251) 479-9597

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Monday-Thursday: 8AM-5PM
Friday: CLOSED

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