New Patient Forms

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In order for us to constantly improve our services to the public and provide you with the best possible orthodontic and TMJ treatment, without wasting any of your time, please read the following instructions in order to bring the proper New Patient Forms listed below to your first ORTHODONTIC or TMJ consultation appointment.

It is much easier for you to fill in these forms in the comfort of your own home where you have access to information such as insurance company names and numbers, doctors’ names and numbers, etc. You will also spend less time in our office when you bring these forms with you to your first appointment.

Our satisfied patients ask us to do all we can to attract more children, teens and adults to our practice. Before you forget how you found our website or practice, please print and fill in form number 1. With your help, we will be able to help more people improve the quality of their lives.

Thank you.

  1. HOW DID YOU FIND OUR WEBSITE/PRACTICE?

    After you filled in form number 1, please review form number 2 on your computer screen to see if you have any of the signs and symptoms of TMJ. If you or someone in your family has any of these signs and symptoms, please print form number 2 and mark all those that apply. You can learn more about this on the TMJ & TMD page of our website.

  2. TMJ-TMD-MSD SIGNS AND SYMPTOMS

    If you or a family member do NOT have any of these signs and symptoms, print and fill in form number 4.

    If you or a family member has any of these signs and symptoms, please print and fill in form number 3, and call our office to schedule a one hour TMJ diagnosis and treatment plan appointment before scheduling a free orthodontic consultation appointment. Our fee for this one hour TMJ evaluation is $150.

    When you come in for the free orthodontic consultation and Dr. David Alpan discovers that you have TMJ problems, you will have to schedule another appointment for a TMJ consultation. It is in your best interest to have TMJ diagnosis and treatment before orthodontic treatment begins. This will be explained in more detail when you come in for your first appointment.

  3. TMJ-TMD-MSD QUESTIONNAIRE

    Please print and fill in form number 4 before you come to our office for a free orthodontic consultation or a $150 TMJ diagnosis and treatment plan appointment.

  4. NEW PATIENT INFO & HEALTH QUESTIONNAIRE

    Please bring all the appropriate forms above with you to your first appointment at Aesthetic Orthodontics. Thank you. We look forward to meeting you and helping you improve the quality of your life.

If your smile is not becoming to you, you should be coming to Aesthetic Orthodontics in our Los Angeles, California; Beverly Hills, California, or Las Vegas, Nevada, office.

We look forward to welcoming you into our TLC orthodontic specialty practice.