Please help us be prepared for your first appointment by completing our Medical & Dental History form and HIPAA form. Download the forms, complete them and email them to our office, or bring them with you.

• Medical & Dental History (to be filled out)
  Word format | PDF format
• HIPAA Notice of Privacy Practices (read only)
  Word format | PDF format
• HIPAA Privacy Acknowledgement (to be signed)
  Word format | PDF format

Privacy Policy

Recently, the United States Department of Health and Human Services ("HHS") issued comprehensive regulations relating to the privacy of patients' records. It is the intent of this office to comply with each of these new rules, and this policy is designed to provide a framework to accomplish this goal.

• Ortho2Smile Privacy Policy
  Word format | PDF format

Informed Consent

All forms of medical and dental treatment, including orthodontics, have some risks and limitations. Fortunately, in orthodontics the complications are infrequent and when they do occur, they are usually of minor consequence. Nevertheless, they should be considered when making the decision to undergo orthodontic treatment.

• Oral Hygiene: Cavities or permanent markings such as white lines or spots (decalcification) on the teeth can occur if patients do not brush and floss frequently and properly. Inflammation of the gums or loss of supporting bone can occur if bacterial plaque is not removed daily with excellent oral hygiene. It is important to continue with regular visits to the family dentist during orthodontic treatment for thorough cleaning and early detection of any developing problems.
• Tooth Vitality: A tooth that has been previously injured by a blow or has a large filling may require root canal therapy when it is moved by orthodontic appliances. PLEASE report any sensitivity to hot, cold or sweets.
• Root Resorption: In some cases, the length of the roots of some teeth may be shortened during orthodontic treatment. Usually this is of no consequence, however on rare occasions it may require curtailing treatment to avoid loss of a tooth or teeth. Dr. Radu will evaluate your diagnostic records prior to, and after treatment to check for root resorption.
• Unpredicted Jaw Growth: Occasionally a person who has normal growth of the jaws may not continue to do so. The relationship of the jaws may change requiring additional treatment or in some cases surgery to correct.
• TMJ Concerns: Some patients may suffer from noise or pain in the temporomandibular joint (joint of the lower jaw, near the ear). This may occur before, during or after orthodontic treatment. It also affects people who never had orthodontic treatment. If a problem develops, we will evaluate the situation; specific treatment may be required, beyond the scope of routine orthodontic care.
• Length of Treatment Time: The total length of treatment time can be longer than originally estimated. Lack of bone growth, poor patient cooperation, broken appliances and missed appointments are all important factors which can lengthen treatment and affect the quality of the result.
• Retention: All living tissues change as we mature. Teeth and gums are no different. In order to keep changes to a minimum, good retainer wear is essential and long-term retention is recommended.

It is essential that you inform the office of any change in your medical or dental history. If you have any questions at any time regarding this information, please do not hesitate to ask.