Walton Orthodontics
Patient Forms

Prior to your complementary consultation please take a moment to complete the online Patient Registration & Medical Forms. We will hold your information with the strictest confidence and security.

Child Medical History Form

Adult Medical History Form

You may submit the form securely online or print a hardcopy and bring it to your consultation.

Note for online submissions:
Please print a copy for your records prior to submitting the form online.
If prompted to enter an email address use:
registration@waltonorthodontics.com

Our Team

We welcome you! The Team

 

 

 

      

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         1505 SW Cary Pkwy, Suite 207 • Cary, NC 27511 • 919.249.4900 • Fax: 919.249.4903

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         © 2012  Mary H.G. Walton, DDS, MS  |  www.WaltonOrthodontics.com