We are pleased to offer the convenience of secure online forms. Please choose the appropriate form below. Upon completion, the form will submit directly to the office of Dr. Allen Zuch. Your information will be used for the sole purpose of your orthodontic treatment.
Step 1
• New Patient Form (be sure to fill in all required fields).
• COVID Health Questionnaire
• Click here to read our complete HIPAA policy.
Updates
CONTACT INFO UPDATE
MEDICAL UPDATE
INSURANCE UPDATE.
Step 2
Please Register To The Patient Portal (your temporary password is emailed to you 24 hours after scheduling your appointment. Look for the subject: THE TOOTH MOVER Patient Online Portal)
