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Patient Forms

Save time at the Benkovich Orthodontics and fill out your registration and health history information online! Take a few minutes to fill out this confidential form, click the link below and fill out all information. When completed you will see "Submit Form" button at the bottom, and your information will be sent to our office with secure encryption. We will already have your information when you arrive for your first appointment. 

New patient form

COVID 19 FORM (to be filled out the day of your appointment): 

http://www.orthocalc.com/covid/benkovich-orthodontics

At Benkovich Orthodontics, we are committed to safeguarding your privacy and ensuring the security of your personal information. The information you provide to us will be used solely for the purpose of scheduling your Orthodontic appointment and ensuring you receive the best possible care.

We may collect and process personal information such as your name, contact details, and relevant health information. Rest assured that this information will be treated with the utmost confidentiality and will not be shared with any third parties without your explicit consent, except as required by law.

By providing us with your information, you consent to the use of that information as outlined in this privacy policy. If you have any concerns or questions about how your information is handled, please feel free to contact us.

Thank you for choosing Benkovich Orthodontics. We look forward to providing you with exceptional Orthodontic care.

Thank you!

 

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