Orthodontist Churubusco IN | Fort Wayne


See Our Reviews
Ron Cohen, DDS, MSD
Joel Johnson, MS, DMD, MSD
“Orthodontics 3D”

FORT WAYNE
(260) 489 8989 toll free: (888) 444 2128

CHURUBUSCO
(260) 693 3452

Patient Forms

smiling mom and daughter

Please take a minute to fill out the patient information form before your first appointment:

Fill out our Online Health History Form: [Click Here]


For your convenience, we also have all of our forms available for you to download and fill out, if you would prefer. You may also call our office and speak with someone if you need additional assistance.  Whether you choose to submit the online forms or the downloadable forms, filling these out prior to your first appointment allows us to prepare to make your visit as efficient and comfortable as possible. Thank you!

  • Health History (Child) [DOC]
  • Health History (Adult) [DOC]
  • TMD History [DOC]
  • Head Health History Form [DOC]
  • Headache History [DOC]

 

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10211 Dupont Circle Drive, Suite A, Fort Wayne, IN 46825
107 McCoy Street, Churubusco, IN 46723