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Havens Orthodontics

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Office Selection

2

Patient Info

3

Date & Time

4

Review & Submit

5

Appointment Scheduled

Office Selection

2

Patient Info

3

Date & Time

4

Review & Submit

5

Appointment Scheduled

New Patient Information

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I have read, understood, and agree to the HIPAA Notice , Privacy Policy, and Terms and Conditions. By checking this box and submitting this form, I agree to receive calls and text messages from Havens Orthodontics at the phone number provided, including messages sent using automated technology, regarding my appointment, intake, or orthodontic care. Message frequency varies. Message and data rates may apply. Consent is not a condition of purchase or treatment; contact the practice directly to schedule without text messages. Reply STOP to opt out and HELP for help where supported.

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