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Transfer Patient

Female Patient

We recognize that while it is exciting to relocate to Naples, the move can be challenging. We are prepared to help you through this process and make your transition to our practice as easy as possible. To facilitate this transfer of responsibility from your previous Orthodontist to Dr. Cullinan, we require a completed American Association of Orthodontics (AAO) TRANSFER FORM and copies of all existing patient records prior to your first visit with us.

This includes x-rays, photos, treatment chart notes, recommendations, etc. Please reach out to your previous Orthodontist as soon as possible and give them written permission to send your records directly to us by mail or secure email.

 

You will receive a New Patient Packet by mail with helpful information about our office. Included in the packet will be Medical/Dental History forms. Please bring the completed forms and any insurance information to your first visit. This will save you time, will allow us to check your insurance eligibility and benefits, and allow us to make the most effective use of our time together.

New Patient Forms

For your convenience, the Medical/Dental History forms are provided below. These are standard forms designed and approved by the American Association of Orthodontics. One form is for our adult patients, and the other for patients under 18 years of age. Click the link to download the appropriate form, print it out and bring the completed form to your appointment.

For ADULT patient (18 years or older):

AAO Medical Dental History Form – for Adults

For CHILD patient (under 18 years):

AAO Medical Dental History Form – for Patients Under 18 Years

 

Click the PDF icon to download the Transfer Patient Infographic.

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