Patient Forms

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Please print and fill out these forms prior to your appointment. You may scan and e-mail them back to the office prior to your appointment or please remember to bring them with you to your appointment. The team at Chira Orthodontics are all looking forward to meeting you. In the meantime, if you have any questions concerning your paperwork, appointment, or our practice, you can call us at (802) 652-1010.

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Required New Patient Forms: 

• American Board of Orthodontics Brochure

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• Adult New Patient Form

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• Child New Patient Form ​

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• Appointment and Insurance Policy
  
  
  Additional Forms

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• Loose Band/Bracket Policy
   

• Epworth Sleepiness Scale
   

• Berlin Sleep Questionnaire