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Patient Forms

To make the new patient process fast and easy, our practice utilizes secure, online eForms.  They only take a minutes to complete and your answers will be sent to our office automatically - no paperwork required!

Health History eForm

All patients must complete a Health History evaluation before their first visit. HIPAA and other necessary consent forms are also included in the following online questionnaire.

Click the button below to begin.

* Patients who object to using eForms may print the appropriate patient form packet below, fill out the paperwork, and bring it to your first appointment.

ADULT - Patient Forms 

CHILD - Patient Forms

Orthodontic Insurance

Our office will research your orthodontic benefits so that we may accurately provide your financial options at the time of your appointment.  If you have not yet provided your insurance information to our office, take a minute to complete one or both of the questionnaires below. Have your insurance card(s) ready.

Insurance Through an Employer:

This online questionnaire asks a few simple questions used by your insurance company to determine your orthodontic benefits

Click the button below to begin.

Employer Insurance

Pennsylvania (PA) State Insurance:

Patients with insurance through the state need to complete a separate questionnaire.

Click the button below to begin.

State Insurance


What's The First Visit Like?

A short video walking you through a typical first visit to our office.

Getting To Know You

Taking photos, x-rays, and records is only part of the appointment.  As a new patient, we want to learn all about you and your personal needs.

Tell us what matters most to you. Customizing the best treatment plan for every individual means understanding your needs.

Our goal is to give everyone the smile they've always dreamed of!

Contact Us

Highly satisfied with my child's ortho procedure. The entire process has been seamless even with the pandemic. The website and patient portal is user friendly, but should you need to call the office for any reason, a staff member always answers in a friendly manner.  The Ambridge office is stunning, it's like waking into a super hero museum.  Everybody's favorite super hero can be found.  Dr. Spokane has a great chair side manner, upbeat and friendly.  My child was nervous at first but his fear quickly went away with the super comfortable atmosphere.  I recommend Dr. Spokane to all my friends and family.

-Cymone Bronaugh