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Patient Information

Request an Appointment

You may contact our clinic coordinator at 216.368.4331 or email your contact information to olivia.abdlrasul@case.edu to schedule. Our clinic coordinator is available Monday through Friday from 9 a.m. to 5 p.m. to answer questions or address your concerns.

Patient Forms

You may access the following forms to assist us with your care. Please print and fill out the following forms, then bring them to your appointment. (These forms require Adobe Reader.)

Medical History Form for Patients Under the Age of 18

Medical History Form for Adult Patients

HIPAA Acknowledgement Form

New Patient Registration Form

Financials

We accept all insurance providers and work closely with CareSource, the Bureau for Children with Medical Handicaps (BCMH), Delta Dental, and Anthem Blue Cross Blue Shield.

What to Expect From Your First Visit

Orthodontics is but one step in a series of treatments for many patients with craniofacial anomalies. Because craniofacial patients require a team of specialists from birth (or in the case of injury, from the time of an incident), we anticipate working together with the doctors who have treated you to this point. While we can often answer general questions about treatment during the initial examination, we will address specific areas after careful analysis of existing treatment records and consultation with your referring doctors.

We feel it is important to analyze each patient's specific needs, because in-depth planning leads to superior results and higher patient satisfaction. After your initial examination, we will schedule a consultation visit to discuss treatment options, time frames, and financial arrangements. We insist that our patients leave the office with a clear understanding of their specific needs, the nature of the treatment, and how long it will take.

patientinfo

Open Communication
We believe that good orthodontic care begins with open communication. We promise to speak candidly with you about our diagnosis and recommendations, any alternative treatments, and any symptoms that may require further investigation or treatment. Working together, we can achieve a true partnership, with one common goal--helping you achieve a functional and appealing bite and smile.