Patient Forms for Download

The forms and documents below are available as PDF files for convenient download.  If you wish to reduce the wait time during your first visit, please download, print and complete the ‘New Patient Health History Form’ before bringing it into the office.  Other necessary forms are also available below for download.  Thank you!

New Patient Health History Form

Informed Consent Form

Notice of Privacy Practices

Acknowledgement of Privacy Practices

Photo Release and Appointment Reminder Preferences Form

Questions about our forms?  Call (804) 454-1888

 

Patient News & Events

Free Orthodontic Evaluation

Professional Affiliations

Member of the American Association of Orthodontists
Diplomate American Board of Orthodontics
Member of the American Dental Association

Interactive Google Map

Contact Information

Wakeshi Benson, DDS
12230 Iron Bridge Rd., Suite B Chester, VA 23831
Phone: (804) 454-1888
Fax: (804) 454-1868
Website: wb-orthodontics.com
Email: care@wb-orthodontics.com