Patient Forms
Welcome to O·M·I Orthodontics! For your convenience, we have our Health History forms available at the click of a mouse. You may also call our office and speak with someone if you need additional assistance. Filling out these forms before your first visit allows us to prepare to make your visit as efficient and comfortable as possible. Thank you!
Please Take a Minute to Fill Out the Patient Information Form Before Your Consultation
Because your time is valuable, we continually update our procedures to honor your time with us. We developed this system to save you time at our office.
Please complete the health history online. It takes a few minutes from the comfort of your home to fill out this confidential form where you have access to all your essential information.
When completed, click the “Submit” button at the end of the form, and you will send your information to our office with secure encryption. We will already have your information when you arrive for your initial consultation.
Scan the QR code to fill out your Health History form on a mobile device.
Why is Your Health History Patient Form Important for Your Orthodontic Appointment?
Your medical history is very important to us. It helps us understand your overall health and potential conditions that could impact your orthodontic treatment. Please take a few minutes to fill out this form before your appointment so that we can provide you with the best possible care.
What is HIPAA?
HIPAA is the Health Insurance Portability and Accountability Act. It is a federal law that protects the privacy of your medical information. We are required by law to follow specific procedures to ensure that your information is kept private.
If you have any questions, please call our office at (260) 489-8989.
Thank you for choosing O·M·I Orthodontics! We look forward to meeting you soon!
What to Bring to Your First Appointment
For your first appointment, please have available:
- Medication list
- Insurance Card or Information
- Valid ID
During your first visit, we will review your dental and medical history forms and take X-rays of your teeth and mouth. Then we will meet with you to discuss your X-rays, help you create your own individual treatment plan, and answer any questions you may have.
During this visit, not only will our team get to know you, but you will also get to know our team. We welcome your questions, your concerns, and any other information you feel might assist us in providing you with care that is as unique as you are during our time together.
Please don’t be concerned if you haven’t visited an orthodontist. There’s no reason to feel guilty because you’ve already made an important choice to come today. We want you to know that we will do everything in our power to make you feel secure and at ease. Your emotional well-being is just as important to us as your physical well-being.
Quality and Convenience at O·M·I Orthodontics
Dr. Joel Johnson and Dr. Marcus Dager want you to have a positive experience at our office, so we do everything we can to make you feel prepared and informed. We know that most of our patients would prefer to fill out the patient forms online rather than have to fill them out after they arrive at the office. We hope that by providing these resources, you’ll feel more relaxed and confident when you come for your appointment.
Our secure Health History form ensures that all of your information is kept confidential, so you can focus on getting the beautiful smile you’ve always wanted in Fort Wayne, Fishers, and Auburn, Indiana.
We look forward to working with you to build a beautiful smile.
Online Health History Form – Fill out online
To fill out your Health History form on a mobile device scan QR code.
In case you want/need the QR code info:
