Patient Forms

Welcome to Dominion Orthodontics! We’re excited to be part of your smile journey.

To help make your first visit seamless, we offer our patient forms online so you can complete them at your convenience.
Please note that these forms should only be filled out after you’ve contacted our office to schedule your appointment.

Please complete the forms below to save time during your visit and help our team prepare for your personalized treatment experience.

English

New Patient - Child
New Patient - Adult

Spanish

Paciente Nuevo – Niño
Paciente Nuevo – Adulto

If you have any questions or are experiencing any difficulties, please let us know directly at 804-427-7420

Group of five smiling children huddled in a circle outdoors.