Welcome to Coastal Orthodontics
New Patient Forms
For your convenience our new patient forms are available for you to download and complete prior to your consultation appointment. Or you can e-mail completed forms to: [email protected]
English
Acknowledgement of Receipt of Notices
Authorization to use or Disclose Protected Health Information
Letter of Information and Consent Agreement
Spanish
Acknowledgement of Receipt of Notice
Authorization to use or Disclose Protected Health Information
We maintain strict standards and procedures to prevent unauthorized access to your personal information and ensure correct use of information. While we strive to protect your personal information, we cannot ensure the security of any information that you transmit to us over the internet and you do so at your own risk. However, once we receive your transmission, we take reasonable steps to ensure that your information is secure on our systems.