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New Patient Health Information Form

Please join us in making our office greener. Take a few minutes to fill out this confidential form below. Click the “Submit Form” button at the bottom, and your information will be sent to our office with secure encryption.


We strongly encourage you to fill in the form electronically. However, if the on-line form doesn’t work for you, you may download and print a hardcopy to use. Please bring the completed form to your consultation appointment.

Form


Electronic Form


Click Here for your Complimentary Consultation!
Thomas and Leitner Orthodontics in Rock Hill SC

(803) 324-5396

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