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Pediatric Dentistry & Family Orthodontics Logo
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  • Home
  • Services
    • Pediatric Dentistry
    • Orthodontics
      • Braces
      • Treatment Plan
      • Emergency Care
  • Meet The Team
    • Andrew Arcuri, DDS MS
    • Michael Quigley, DDS
    • Michael Weinstein, DDS
    • Young Son, DMD
    • Danny H. Kang, DDS
    • Meet The Staff
    • What Sets Us Apart
  • New Patients
  • Patient Forms & Videos
  • Contact Us
    • Appointment Request
    • Post-Appointment Survey
    • Refer A Patient
Pediatric Dentistry & Family Orthodontics Logo
Google Reviews
  • Home
  • Services
    • Pediatric Dentistry
    • Orthodontics
      • Braces
      • Treatment Plan
      • Emergency Care
  • Meet The Team
    • Andrew Arcuri, DDS MS
    • Michael Quigley, DDS
    • Michael Weinstein, DDS
    • Young Son, DMD
    • Danny H. Kang, DDS
    • Meet The Staff
    • What Sets Us Apart
  • New Patients
  • Patient Forms & Videos
  • Contact Us
    • Appointment Request
    • Post-Appointment Survey
    • Refer A Patient

Orthodontic Consent Form

Parents and patients who are beginning Orthodontic Treatment, please watch Dr. Arcuri's Consent video and sign the Orthodontic Consent form.

You can download a copy of the Orthodontic Consent Form below.

Patient Forms

Please take a minute to print and fill out the patient information form before your first appointment.

Welcome Letter Expand

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Orthodontic Consent Form Expand

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COVID-19 Consent Form Expand

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Office Changes During COVID-19 Expand

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Child Patient Information Sheet Expand

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Adult Patient Information Sheet Expand

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HIPPA Expand

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Electronic Consent Form for Unencrypted Patient Records Expand

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Patient Update Form Expand

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Medical History Update Form Expand

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Orthodontic Problems For Growing Children Expand

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Dental Care For Your Baby Expand

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Food List Expand

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Retainer Instructions Expand

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NPO Instructions Expand

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Records release FROM our office Expand

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Records release TO our office Expand

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Photo Release Form Expand

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Testimonial Form for Patients Expand

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Patient Videos

How to turn your child’s Expander Expand

CLICK BELOW FOR VIDEO

How to turn your child’s Expander

How to complete an Incomplete/ Stuck Expander Turn Expand

CLICK BELOW FOR VIDEO

How to complete an incomplete expander turn

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Privacy Policy

Copyright © [2018] [Pediatric Dentistry & Family Orthodontics] | Powered by [Bleagolf]

We Have Exciting News to Share For All Our Current and Future Patients at Pediatric Dentistry & Family Orthodontics. WE MOVED!!

Our brand-new state of the art facility is located at:

5538 North Burdick Street, Fayetteville, NY 13066

This means that if you have/or need a scheduled appointment with us on or after 6/21/2021 you can look forward to being greeted by our team at the new location.

(COVID policies and procedures are still in place so please review them on our website.)

The next couple weeks are going to be a very exhilarating time for us as we transition to our new home. We will still be available for your calls and will be working diligently to return any calls coming in. If you have an urgent need during the week of 06/14/21 to 06/18/2021 please contact us and leave us a voicemail if we do not answer. If it is not an urgent need please reach out to us on or after 6/21/2021 at the same number 315-637-6961.

Thank you for your patience and understanding we look forward to sharing the new space with you.