Our Location
10 N.W. Chipman Rd.
Lee's Summit, MO 64063
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New Patient Forms

Please assist us by providing the following information at the time of your first visit:

  • Any panoramic X-ray taken within the past six months.
  • If you have orthodontic insurance, bring your insurance card. By providing this information at the first visit, we will be able to give you an estimate of your cost

For your convenience, you may access the following forms to assist us with your care. Please complete the following forms, and click the submit button at the bottom of each form.

*We are committed to keeping your personal information secure. All of our online forms are submitted via a secure connection and are HIPAA compliant.