Matthew David McNutt, DDS, MS, PA
Orthodontics for Children, Teens & Adults

Patient Forms

Patient Forms

INSTRUCTIONS FOR NEW PATIENT CONSULTATION PAPERWORK

Prior to your complementary consultation, please take a moment to print and complete the appropriate forms below.  Completing the paperwork in advance is required.  Always keep the original filled out forms and bring them with you to the sixty minute consultation. Time is not allotted in our consultation for completing the paperwork.  In the event you are unable to complete the required forms in advance, plan to arrive twenty minutes early to your consultation in order to complete the paperwork.

There are three required forms for each new patient:

1) Registration Form.  2) Consent For Exam.  3) Policies Financial & Insurance.

Click on the form titles below to open them.


Child Minor
Registration Form

Adult
Registration Form

Required Consent
For Exam

Policies
Financial & Insurance

In the event you do not have a referral from your family dentist, you may be required to complete a Dental Records Release Form prior to  your consultation.  Click here to open and print the release form:

DENTAL RECORDS RELEASE FORM

In order to view and print our forms Adobe Acrobat Reader (a standard free pdf reader)  is required.

For those able to do so, we do encourage scanning a copy of your completed forms and emailing them to us at registration@thetoothmover.com.

Always keep the original filled out forms and bring them with you to the sixty minute consultation.

Cary Orthodontics

Cary OrthodonticsOffice Address
301 Ashville Avenue,
Suite 101 Cary NC, 27518
Phone (919) 887-6350
Fax
(919) 887-6351
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Clayton Orthodontics

Clayton OrthodonticsOffice Address
400 Tew Court, Suite 108
Clayton NC, 27520
Phone (919) 553-4512
Fax (919) 553-6097
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