New Patient Form

Please help us be prepared for your first appointment by completing this Patient Information and Medical History.

If you’re unable to open PDF files, you can get Adobe Reader® for free.



“No better orthodontics office in the Midwest! 3/4 of our family have been in braces; that is Mom, teen son and teen daughter. We have fully trusted Dr. Robinson’s practice. What a great provider and a friend! R + R Orthodontics staff are caring and confident about doing a great job and meeting their patients needs. Thank you so much for your wonderful treatment over the years.”

~ Mary J.