Orthodontic Consultation Form
An orthodontic consultation form asks what the patient wants changed, in their own words, and what they're willing to wear to change it. Both answers shape the plan more than the clinical assessment alone.
For dental practices, orthodontists and hygienists.
What they'd accept wearing decides the plan
A patient who will only consider clear aligners and one who is happy with fixed appliances get different treatment plans for the same clinical problem - sometimes very different timescales and costs.
Asking about appliance preference, and about a specific event they're working towards, means the first consultation can be about a realistic option rather than a menu. This template also asks about grinding, jaw pain and previous orthodontics, which are the three things most likely to complicate a plan.
The cost of asking twice
Chasing details is invisible work: it doesn't appear on any invoice, but it eats the first week of every new relationship. Worse, it happens at exactly the moment a patient is deciding whether you are organised.
This template front-loads it. One link, one pass, everything you need to open the file - and a written record of what they told you.
Medical history before the chair, not in it
Medical history, medication and anxiety level asked at reception get rushed and under-reported. Sent with the appointment confirmation, they arrive complete, read properly, and give you the ten minutes back.
It also flags the appointments that need different planning - a sedation conversation, a longer slot, a change of technique - before the day rather than at the door.
Nothing to install, nothing to learn
Your patients get a link. No account, no app, no cookie banner between them and the first question. The page is a single file that loads in one request, which on a phone on mobile data is the difference between a submitted form and a closed tab.
Yours to change, immediately
Nothing here is fixed. Rewrite a question, reorder them by dragging, add your brand colour, delete half of it. Save and the live form updates - there's no separate publish step and no deploy to wait for.
What this template asks
- Patient's name
- Date of birth
- Email address
- Phone number
- Who is the treatment for?
- What bothers you about your teeth?
- Which of these apply?
- How long have you been thinking about this?
- What would you consider wearing?
- Aligners need wearing 20 - 22 hours a day. Is that realistic?
- Is there a date you'd like to be finished by?
- Have you looked into costs?
- Have you had orthodontic treatment before?
- Any of these?
- Medical conditions or medication
More Dental forms
Questions
Should we ask about budget?
Ask about awareness of cost ranges rather than a number - orthodontics is a considered purchase and most people have no idea what to expect. A range question starts that conversation gently.
Can patients send photos of their teeth?
Yes - a file question accepts photos and PDFs, up to three at 20 MB each, downloadable only by your team. Most practices still take clinical photographs at the consultation anyway.
Can I add or remove questions?
Yes - every question here is a starting point. Add your own, delete what doesn't apply, reorder by dragging, and make anything required or optional. Saving publishes the change immediately.
Where do the answers go?
Into your dashboard, where you can read, filter and export them as a spreadsheet. You can also have every response emailed to you the moment it arrives, or as a daily or weekly digest.
Do I need a website?
No. Every form gets its own link you can paste into an email signature, a text message, a QR code or a social profile. If you do have a site, you can link to it from anywhere on it.
Can this hold patient medical information?
Responses are stored in your account, never shared, and served over encrypted connections - but you are the data controller. Ask only what you need clinically, tell patients what you keep, and check your local rules (HIPAA, UK GDPR and similar) before using a web form for health data.
Publish your orthodontic consultation form today
Start from this template and change anything you like. Free to begin.