NEW PATIENT START FORMS
FIND THE CASE TYPE, FEE TIER, AND TREATMENT METHOD THAT MATCHES WHAT THE PATIENT SIGNED UP FOR.
COMPREHENSIVE
COMPREHENSIVE MINUS (BRACES)
COMPREHENSIVE MINUS (BRACES)
COMPREHENSIVE STANDARD (BRACES)
COMPREHENSIVE STANDARD (BRACES)
COMPREHENSIVE PLUS (BRACES)
COMPREHENSIVE PLUS (BRACES)
COMPREHENSIVE MINUS (ALIGNERS)
COMPREHENSIVE MINUS (ALIGNERS)
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COMPREHENSIVE STANDARD (ALIGNERS)
COMPREHENSIVE STANDARD (ALIGNERS)
COMPREHENSIVE PLUS (ALIGNERS)
COMPREHENSIVE PLUS (ALIGNERS)
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LIMITED
LIMITED BASIC (BRACES)
LIMITED BASIC (BRACES)
LIMITED BASIC (ALIGNERS)
LIMITED BASIC (ALIGNERS)
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PHASE I
PHASE I (BRACES)
PHASE I (BRACES)
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PHASE I (BRACES + APPLIANCE)
PHASE I (BRACES + APPLIANCE)
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RETREAT
RETREAT (BRACES)
RETREAT (BRACES)
RETREAT (ALIGNERS)
RETREAT (ALIGNERS)
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MEDICAID
MEDICAID APPROVED NEW PATIENT CONTRACT
MEDICAID APPROVED NEW PATIENT CONTRACT
COMPREHENSIVE BRACES [MEDICAID DENIED]
COMPREHENSIVE BRACES [MEDICAID DENIED]
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