Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

Patient Medical History Form

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

Patient Medical History Form
history.pdf
Adobe Acrobat document [9.5 MB]

Privacy Notice

Please read over and sign our Notice of Privacy Practices, acknowledging our privacy policy. This form should also be brought to your first appointment.

Privacy Notice
hippa.pdf
Adobe Acrobat document [404.2 KB]

Make Your FREE Orthodontic Evaluation Today!

T 818-848-0100

F 818-848-1301

 

Pita Orthodontics 

500 E. Olive Ave., Suite 630

Burbank, CA 91501

"We'll Make You Smile"

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