Adrian, Michigan 49221
Phone: 517•263•1563
Fax: 517•265•2890
info@adrianortho.com
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Here's where you will find all the necessary information you will need for your first visit with Dr. Weeden.
New Patient Forms
The following forms should be completed prior to the first visit. Please have the completed forms ready for the New Patient Coordinator at your first appointment:- Notice of Privacy Practices: This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully. An Acknowledgement of Privacy Practices form describes how medical information about you may be used and disclosed, and how you can get access to this information. The Privacy Consent form is optional under the new patient privacy regulations recently issued by the United States Department of Health and Human Services. We have elected to use this form. Prior to commencing your orthodontic treatment, you should review, print out, sign, and date thrse forms. Bring them with you to your first appointment.
- New Patient Questionnaire: The questionnaire includes contact and insurance information as well as your medical and dental history. You may fill out this form online and submit it via secure email, or print it off, fill it out, and bring it with you to your first appointment.
This is a larger version of the map found on the Location page.
Click Here for Payment Information
This page describes payment options.
Click Here for What to Expect at
Your First Visit
This page describes what will happen during your
first visit to Dr. Weeden.
Some of these documents are provided in Adobe Acrobat PDF Format. To obtain the free Acrobat Reader, follow this link, or click on the icon below.
Copyright ©
2009, Josephine C. Weeden D.D.S., M.S., P.C.