Patient Forms | Diers Orthodontics

Hooray! Governor Dewine has given dental offices in Ohio the go ahead to open our doors and begin serving our patients again! We will be following the guidance provided to us by the Ohio State Dental Board as well as the American Dental Association and the CDC.

We ask that you please be patient with us as we navigate this uncharted territory together. It continues to be our priority to serve you to the best of our ability in the safest environment possible.

PLEASE AWAIT OUR PHONE CALL. This will allow us to serve you better. Our goal is to have contacted everyone by May 18th. If you have not heard from us by then and have concerns please feel free to reach out.

Please be checking your email for any updates or changes. We look forward to seeing you all again soon.

Patient Forms

Already have an appointment?

To save you time at your initial visit, we have provided the necessary new patient forms below. Simply download, print and complete the forms (PDF), and bring to your appointment.

All patients should complete a new patient form, the HIPPA privacy policy and a sleep assessment. Adults or children, if you are experiencing any jaw problems, such as pain, noise in the joint, or headaches, please complete the TMJ form as well.

Our Mission

To constantly improve the orthodontic experience with superior innovative service.

To positively affect our patients lives with an honest, trusting, and considerate orthodontic team.

To grow together in mind, heart, and spirit with superior management, emphasizing communication, encouragement, kindness, and patience.