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Smile Appeal Orthodontics

Address:
North Office
4401 W Memorial Rd, Ste 113
Oklahoma City, OK 73134

South Office
7421 S Western Ave
Oklahoma City, OK 73139

Phone:
(405) 752-0300 – North Office
(405) 634-4700 – South Office

Hours:
Mon–Thu: 9:00 AM–6:00 PM

Contact Us

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Child's Gender
Do you have legal custody of this child
Orthodontic Coverage
Orthodontic Coverage_2
Has the child ever had a serious problem associated
Hepatitis
Nail Biting
Nursing Bottle Habits
Heart Murmur
Congenital Heart Defects
Cancer
Convulsions/Epilepsy
Is the child’s water fluoridated?
Diabetes
Abnormal Bleeding
Is the child taking fluoridated supplements?
Rheumatic Fever
Hearing Impairment
Has the child ever had any pain or tenderness in the
HIV+/AIDS
Any Operations
Hemophilia
Any Stays in Hospital
Does the child brush teeth daily?
Asthma
Kidney/Liver Problems
Do they floss their teeth daily?
Handicaps/Disabilities
Tuberculosis
Allergies to Any Drugs
Prosthesis
History of Scarlet Fever
Is the child currently under the care of a physician
please describe the child's health
Thumb Sucking/Finger Sucking
Lip Sucking/Biting
x

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