New Patient Form

If you would like to save time at your consultation appointment, you may download and  fill out the required patient information forms prior to your appointment.  You can either send the forms to us or bring them with you to the appointment.

If you are unsure of your orthodontic insurance benefits, please send or call us to give us your insurance information to verify your benefits prior to your appointment.

We will need the following information for insurance verification:

  • Insurance name

  • Subscriber name

  • Subscriber date of birth

  • Employer's name

  • Patient name

  • Patient's date of birth

  • Member ID or SSN

  • Group number if applicable

Kind Orthodontics | Orthodontic Services Available to Dublin, California

KIND ORTHODONTICS | AAO Logo | Member

777 Southland Drive, Suite #100

Hayward, CA 94545

Phone (510) 361-0300

Fax (510) 361-0304

info@kindortho.com

KIND ORTHODONTICS | ABO Logo | Member | American Board of Orthodontics

©2018 by Kind Orthodontics.