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  • New Patients
    • Why Choose Us
    • Patient Forms
    • Your First Visit
    • Financial Information
    • Pay My Bill
    • Patient Rewards Login
    • Free Consult
  • About Us
    • Meet Dr. Mike Upton
    • Meet the Team
    • Reviews & Testimonials
    • Careers
    • Blog
  • Our Treatments
    • Invisalign
    • Metal Braces
    • Clear Braces
    • Surgical Orthodontics
    • TMJ / TMD
    • TADS
    • Mouthguards
    • Orthodontics for All Ages
      • Adults
      • Teens
      • Children
    • Orthodontic Info
      • FAQs
      • Ortho Emergencies
      • Ortho Care
      • Life With Braces
  • Contact Us
    • Free Consult
    • Tuscaloosa Office
    • Demopolis Office
    • Refer a Friend
    • Review Us
    • Pay My Bill
    • Rewards Login
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Tuscaloosa

815 Rice Mine Rd N.
Tuscaloosa, AL 35406
(205) 752-4343

Demopolis

933 US-80
Demopolis, AL 36732
(334) 287-0200

Patient Forms

Save Time at Your First Visit

To keep your appointment running smoothly, we'll email you your new patient forms so you can fill then out securely and easily.

Online

For your convenience, we are now supporting online health history forms.

Adult New Patient Forms Child New Patient Forms

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If you prefer to print your forms, please print, fill these out, and bring them to your next appointment:

Adult New Patient Form Child New Patient Form

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Two Great Offices

With two state-of-the art offices in Demopolis and Tuscaloosa, AL, great orthodontic treatment is minutes from your home, work or school.

Tuscaloosa

815 Rice Mine Rd N.
Tuscaloosa, AL 35406

(205) 752-4343

Demopolis

933 US-80
Demopolis, AL 36732

(334) 287-0200

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