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707.963.1203

176 Main Street, Suite A,
St Helena, CA 94574
  • Home
  • About Us
    • Meet Our Doctors
    • Patient Testimonials
  • About Orthodontics
    • Types of Braces
    • Early Treatment Phase I and Phase II
    • Adult Treatment
    • Braces 101
    • Caring For Braces
    • Common Orthodontic Problems
    • Retention
    • Oral Surgery
    • Glossary
  • Patient Center
    • Your First Visit
    • Financing Your Treatment
    • New Patient Forms
    • Oral Hygiene
    • Before and After Gallery
    • Emergencies
    • Contests and Fun
    • Frequently Asked Questions
  • Invisalign
    • Invisalign Cost
    • Invisalign FAQ
    • Invisalign Teen
  • Contact Us
    • Request An Appointment
    • Doctor Referral
Request An Appointment

707.963.1203

176 Main Street,
Suite A,
St Helena, CA
  • Home
  • About Us
    • Meet Our Doctors
    • Patient Testimonials
  • About Orthodontics
    • Types of Braces
    • Early Treatment Phase I and Phase II
    • Adult Treatment
    • Braces 101
    • Caring For Braces
    • Common Orthodontic Problems
    • Retention
    • Oral Surgery
    • Glossary
  • Patient Center
    • Your First Visit
    • Financing Your Treatment
    • New Patient Forms
    • Oral Hygiene
    • Before and After Gallery
    • Emergencies
    • Contests and Fun
    • Frequently Asked Questions
  • Invisalign
    • Invisalign Cost
    • Invisalign FAQ
    • Invisalign Teen
  • Contact Us
    • Request An Appointment
    • Doctor Referral

New Patient Forms

Please help us be prepared for your first appointment by completing the provided forms. Click on the health history form and fill out online. Download, print, complete, and bring the other appropriate forms below with you to your first appointment.

English

Health History Form

HIPAA Notice of Privacy Practices

HIPAA Acknowledgement of Receipt

Spanish

Adult History Form

Child History Form

HIPAA Notice of Privacy Practices

HIPAA Acknowledgement of Receipt

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ST HELENA ORTHODONTIC OFFICE

176 Main Street, Suite A,
St Helena, CA

CONTACT INFO

St Helena: (707) 963-1203

Email: info@upvalleyortho.com