Patient screening form 2026

1. Click ‘Get Form’ to open the patient screening form in the editor.
2. Begin by entering the patient's name, home address, phone number, birthdate, school and grade, hobbies, age, and gender in the designated fields.
3. Identify the primary responsible party by selecting from options such as Mother, Father, Self, etc., and fill in their name and contact details.
4. Complete the referral section by indicating who referred you to the practice. Fill in any relevant names or sources.
5. Provide insurance information if applicable. Indicate whether you would like Barakat Orthodontics to check your orthodontic insurance benefits.
6. Fill out the health history questionnaire by checking any relevant medical conditions or concerns that apply to the patient.
7. Finally, certify that all information is correct by signing and dating at the bottom of the form.

Start filling out your patient screening form online for free today!