beautiful smiles for a lifetime

Forms

Thank you for choosing Wazio Orthodontics for your new smile. We look forward to meeting you on your first visit to our office. During this time, we will help you get acquainted with our office and learn about what you would like to achieve through orthodontic treatment. We understand that each patient’s needs are different, and we promise to give you the personal attention you deserve.

Please take a minute to complete the patient information forms below before your first visit to Wazio Orthodontics. A thorough medical history is essential to a complete orthodontic evaluation. Please know that your answers are for office records only and are completely confidential.

Click below to access our forms.

Orthodontic Insurance Information Form


Online Health History Form


General Office Policies Form (PDF)


Treatment Consent Form (PDF)


Privacy Notice Form (PDF)


Acknowledgement of Review of Privacy Practices (PDF)


Photography Release Form (PDF)


General Contest Rules (PDF)

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137 1st Street
Batavia, IL 60510 • 630.879.7774
403 S. 3rd Street
St. Charles, IL 60174 • 630.584.6050