New Patient Information & Health History Form

Please join us in making our office greener. Take a few minutes to fill out this confidential form below. Click the “Submit Form” button at the bottom, and your information will be sent to our office with secure encryption. Please take a look at our privacy policy to learn more about your information as it pertains to your treatment with Limbaugh Orthodontics.


We strongly encourage you to fill in the form electronically. However, if the on-line form doesn’t work for you, you may download and print a hardcopy to use. Please bring the completed form to your consultation appointment.


*If you’re printing your form and running low on color ink, please choose the black and white option on your printer. Both color and black and white forms are acceptable.


Child Form Adult Form TMJ Form

Electronic Form

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At Limbaugh Orthodontics, we do not want anything to get in the way of a perfect smile. We offer each and every patient we see a free smile assessment.

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