Kindly fill in the new patient questionnaire form below
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I the undersigned acknowledge that the information stated is true and correct and accurately represents the medical history of the person receiving treatment. If any personal or medical history changes I will notify Peel Orthodontics immediately to update my records.
In the event that the account is not paid within our normal trading terms, I/we agree to pay all late charges and any debt collection costs associated with the collection of these overdue fees.
Here at Peel Orthodontics, we are proud of the smiles we create for you. We would love to show off your smile, not just for their gorgeous looks, but also for education and scientific purposes. The mediums in which this could happen include, scientific journals and lectures, our web page and our in-practice presentations. We are committed to providing you with excellence in orthodontics and consider continuing education and keeping updated in the latest orthodontic technology an integral part of this. Please give us permission to use your clinical photographs, as this will allow us to contribute to the improvement of orthodontics worldwide. I consent to the photographic records being available for use by Peel Orthodontics for the reasons listed above.
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No more metal
Let your parents know why Invisalign for teens might be a better choice for you.
Suite 3/5 Murdoch Dr