• Our Practice
    • Meet Dr. Rodney Torres
    • Meet the Team
    • Maps and Directions
    • Office Tour
  • New Patients
    • Why Choose Us
    • Before and After
    • Reviews & Testimonials
    • Office Visits
  • About Orthodontics
    • Orthodontic FAQs
    • For Children
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    • Brushing and Flossing
    • Emergency Care
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  • Treatments
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    • Two-Phase Treatment
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Free Consult
Free Consult

New Patient Form

  • (813) 920-7720
  • 10870 Sheldon Rd. Tampa. FL 33626

Step 1 of 5 - Patient Information

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Patient's name*
MM slash DD slash YYYY
Sex
Address*
Has the patient had a previous orthodontic consultation?*
Previous orthodontic treatment?*
Marital Status
Mailing Address
MM slash DD slash YYYY

Note:-

If no insurance, please skip to step 4.
MM slash DD slash YYYY
Does anyone else in the family have a similar orthodontic problem?
Does the patient receive regular dental checkups?*
Is patient satisfied with past dentistry?*
Does the patient currently have, or has the patient ever had any of the following?
Patient's overall health status?*
Is the patient presently under medical care?*
Has the patient ever been hospitalized?
Does the patient currently have, or has the patient ever had any of the following?
Patient's/Parent's signature to verify above information

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The first step toward achieving a beautiful, healthy smile is to schedule an appointment.

Free Consult

Our Office Hours

Monday - 7:30am-5:00pm
Tuesday - 7:30am-5:00pm
Wednesday - 7:30am-6:00pm
Thursday - 7:30am-5:00pm

Our Practice

  • Meet Dr. Rodney Torres
  • Meet the Team
  • Office Tour
  • Maps and Directions

New Patients

  • Why Choose Us
  • Before and After
  • Reviews & Testimonials
  • Office Visits

Get Started

  • Schedule Free Consult
  • Virtual Consult
  • Your First Visit
  • Financial Information
  • Patient Forms
  • Refer a Friend
  • (813) 920-7720
  • (813)920-5331
  • info@torresortho.com
  • 10870 Sheldon Rd. Tampa. FL 33626

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