Rewards Program!

To help us learn more about you as our patient, please print and fill out both forms below and bring them with you to your initial consultation. The privacy notice is for your records.

Privacy Consent Form:
A form that gives Kozak Orthodontics permission to access records on your behalf pertaining to your case. This form is needed on your first visit.
download here
New Patient History Form:
This forms helps us get to know you and a little bit about your dental/orthodontic history. It also helps you convey any previous or current problems you have that need to be addressed. To save time you can print and fill this out before you come to your first visit!
download here
Privacy Notice Form:
The privacy notice is for your records only.
download here

* All forms on this site require the use of Adobe Acrobat Reader to view. It is a free plug-in that allows anyone to view .pdf documents.
Click the Adobe logo to download.
Adobe Acrobat Reader

Below is a collection of informational forms that will help answer questions you may have about our office policies.

Kozak Ortho Overview Letter Treatment Philosophy
Kozak Cash Incentives Fees Overview
Transfer Policy Insurance Guidelines
Scheduling Appointments
Kozak Orthodontics. 2011