Gold Orthodontics Meridian Idaho

New patient information form

The Patient

Responsible party 'A' Information

Responsible party 'B' Information

Dental Insurance Information

Medical History

Previous medical conditions

Select "Yes" to any of the following medical conditions below that you have had or currently have:

Dental History


Benefits of Orthodontics: Aesthetics, Health, and Function. Orthodontics is a service that provides an improvement in the appearance of the teeth, in the general function of the teeth, and in general dental health. Teeth, gums, and jaws are an intricate body part and can fail to respond to treatment. If good oral hygiene is not practiced, tooth decay and enlarged gums can result. Joint discomfort and root shortening are observed in a small percentage of cases. Teeth change throughout our lifetime and there can be some movement of teeth and some change after treatment. In addition, I authorize Dr. Gold to perform a complete orthodontic evaluation.