Complete your
medical history form online

To make your first appointment as smooth as possible, we recommend completing your medical history form ahead of time. It helps us prepare for your visit and ensures we have all the right information to tailor your care.

Your details are kept completely private and secure. If you have any questions while filling out the form, just give us a call.

Please complete the form below before your appointment to help us get everything ready for you.

Complete your medical history form online
Patient Details

Person responsible for this account*

Dental History

Medical History

Have you had any of the following?

How did you find out about Knox City Orthodontics?

For further information about how we use your data, please see our privacy policy.