Patient Forms - Orthodontic


Please take a minute to print and fill out the patient information form before your first appointment:

Dr. Rubenstein — Child and Adult Orthodontic Forms

  • Child Patient Registration Form PDF
  • Adult Patient Registration Form PDF

If you’re unable to open PDF files, you can get Adobe Reader® for free.

* We are committed to keeping your personal information secure. All of our online forms are submitted via a secure connection and are HIPAA-compliant.