Orthodontic Consultation Form
One-page form for a first orthodontic consultation: main concern, prior treatment, jaw symptoms, and the times that suit an initial appointment.
A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 12 questions, 1 page, 2 conditional rules.
- Questions
- 12
- Pages
- 1
- Layouts
- classic · card
- Time to complete
- ≈ 3 min
- Conditional rules
- 2
Searches this template answers
- orthodontic consultation form
- braces consultation request form
- orthodontist appointment form
- orthodontic intake form online
- first orthodontic visit form
- invisalign consultation form
Also filed under
Live preview and test console
This is the real form. Answer it to test the 2 conditional rules — nothing is sent or stored.
2 questions are hidden by conditional logic right now — change an answer above to reveal them.
Compliance checklist
- Payment items priced — passingEvery payment question charges a real amount, so a submission always records a payment.
- Conditional logic resolves — passingEvery rule points at a question or page that exists in this template.
- Medical disclaimer present — passingThis form does not provide medical advice, diagnosis or treatment. Information you share here is not a substitute for care from a qualified clinician. In an emergency, contact your local emergency service immediately.
- Question labels unique — passingLogic and exports address questions by label, so duplicates are ambiguous.
What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.
Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.
Who this template is for
Orthodontic Consultation Form is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.
- Small teams who need a reliable intake process working in healthcare & clinical.
- Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
- Anyone replacing chasing missing details over email with one structured record per enquiry.
- Respondents are the people you send it to — the form asks them 12 questions across 1 screen.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.
- 9 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It collects a verified email address so replies and confirmations land.
- It captures a phone number for urgent follow-up.
- It pins the request to a specific date.
- It allows multiple selections without free text.
- Conditional logic hides 2 questions until they are relevant — shorter forms convert better than long ones.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Orthodontic Consultation Form lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 2 conditional rules ship with it.
- Features advanced show logic: if “Have you had orthodontic treatment before?” is Yes, the form dynamically exposes “What treatment, and when?”. Otherwise that question never appears.
- Features advanced show logic: if “Do you have any jaw pain or clicking?” is Yes, the form dynamically exposes “Describe the jaw symptoms”. Otherwise that question never appears.
- All 2 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
About this template
Most orthodontic consultations start the same way: someone noticed crowding, a bite that feels off, or a jaw that clicks, and wants to know what can be done. This single-screen form gathers enough of that story to prepare a useful first appointment without turning into a full intake. It asks who is being referred, what the main concern is from a short list, and then a couple of sentences in the patient's own words about what prompted the visit now. Two yes/no questions do real work: whether orthodontic treatment has happened before, which changes what the consultation needs to cover, and whether there is jaw pain or clicking, which some practices want flagged before the patient sits down. Both open a short box only when the answer is yes. The form closes with availability and a preferred contact method, so the practice can offer a slot with the reply rather than starting a back-and-forth.
What this form asks
Every question is editable — rename it, make it optional, or delete it entirely.
Consultation request
- Patient full namerequired
- Date of birthrequired
- Phone numberrequired
- Email addressrequired
- Referring dentist, if any
- Main concernrequired
- What prompted this consultation?required
- Have you had orthodontic treatment before?required
- What treatment, and when?
- Do you have any jaw pain or clicking?required
- Describe the jaw symptoms
- Availabilityrequired
12 questions in total.
Example of a completed orthodontic consultation form
A sample request showing how a new patient describes their concern before a first consultation.
- Patient full name
- Sofia Marchetti
- Date of birth
- 22/06/2009
- Referring dentist, if any
- Dr. Owen Blake
- Main concern
- Crowding or spacing
- What prompted this consultation?
- Front teeth have become noticeably more crowded over the past year
- Have you had orthodontic treatment before?
- No
- Do you have any jaw pain or clicking?
- No
- Availability
- Weekday afternoons, Saturdays
Sample data — no real people, addresses or records are shown.
How the form changes as it's filled in
This template ships with 2 conditional rules, grouped into 2 behaviours driven by 2 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.
Driven by “Have you had orthodontic treatment before?”
- Reveals questions
If “Have you had orthodontic treatment before?” is Yes, the form reveals “What treatment, and when?”.
Driven by “Do you have any jaw pain or clicking?”
- Reveals questions
If “Do you have any jaw pain or clicking?” is Yes, the form reveals “Describe the jaw symptoms”.
Set it up step by step
- 1
Offer a slot in the confirmation
The availability answers exist so the first reply can propose a real time, not ask when the patient is free.
- 2
Flag repeat treatment before the visit
A patient who has had braces before needs prior records requested ahead of the appointment, not on the day.
- 3
Route jaw symptoms to the right clinician
Where the practice separates jaw assessments from routine alignment work, use that answer to book the right person first time.
- 4
Keep it to one screen
This form exists to book a consultation, not to replace the intake completed once the patient is seen.
Mistakes to avoid
- Asking for a full medical history here, which belongs in the new patient intake once the consultation is booked.
- Leaving the jaw symptom answer unread until the appointment, when it was meant to change how the visit is prepared.
- Offering no availability options, which turns a one-step booking into an email exchange.
What it pairs with
Most teams don't run this form on its own. These are the forms and systems it sits next to.
What to do with the responses
Book the consultation using the availability given, request prior orthodontic records where treatment happened before, and send the new patient intake ahead of the visit.
Works in both layouts
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Privacy & compliance
This form collects health information. Keep access limited to the people who need it, turn on encrypted answers for the clinical questions, and set a retention window so records don't sit in the dashboard forever.
Frequently asked questions
Does this book Invisalign or braces specifically?
No. It books the first consultation where the actual options are discussed; the form deliberately does not ask the patient to choose a treatment type in advance.
Is X-ray or record information needed here?
No. Records are normally taken at the consultation itself; this form only covers what is needed to schedule that visit.
Can adults use this form too?
Yes. Nothing on it assumes a child patient, though a parent or guardian should complete it for a minor.
What if jaw pain sounds urgent?
This form is not a same-day route. Say clearly in your intro what to do if someone needs to be seen sooner than a booked consultation.
Is the Orthodontic Consultation Form template free to use?
Yes. You can preview and test Orthodontic Consultation Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Orthodontic Consultation Form template ask for?
It asks 12 questions across 1 page, 9 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Orthodontic Consultation Form form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this healthcare & clinical form work?
2 conditional rules ship with the template: Features advanced show logic: if “Have you had orthodontic treatment before?” is Yes, the form dynamically exposes “What treatment, and when?”. Otherwise that question never appears. Features advanced show logic: if “Do you have any jaw pain or clicking?” is Yes, the form dynamically exposes “Describe the jaw symptoms”. Otherwise that question never appears. All 2 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other. All rules are editable in the Logic tab.
Where do responses to the Orthodontic Consultation Form form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Orthodontic Consultation Form form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
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