New Patient Forms

Your first visit at Orchard Dental Care will consist of a medical history review and a comprehensive dental exam (including all necessary digital x-rays). During this comprehensive exam, Dr. Rentz will evaluate for oral cancer risks and signs, TMJ symptoms, presence of gum disease and diagnosis any restorative treatment needs. Based on this comprehensive exam and any additional oral health goals you might want to explore, Dr. Rentz will work with you to create a treatment plan that will bring health and confidence back to your smile.  During the comprehensive exam, it will also determine what type of cleaning you need based on the findings of your gum disease screening.

Please assist us by providing the following information at the time of your New Patient appointment:

Any medical conditions that may be of concern prior to treatment (e.g., diabetes, high blood pressure, artificial heart valves or joints, rheumatic fever, etc.) or if you are currently taking any medication (e.g., heart medications, aspirin, anticoagulant therapy, etc.)

A complete list of medications you are presently taking

Dental Insurance Information – In order to help us accurately and promptly process claims, we will need your insurance carrier’s name (e.g. Delta Dental), the Subscriber’s name and date of birth, the Subscriber’s ID number, the policy’s group number, and the patient’s date of birth.

X-rays taken by a previous dentist – If you have recently had x-rays taken by another provider and would like to have them transferred to our office, you can download the ‘Records Release’ form below and provide the transferring office with a signed copy of this release.