Patient Forms

Dr. Glicksman and her staff are excited to meet new, prospective patients!

Your initial consultation is complimentary and will take approximately 30 minutes. Dr. Glicksman will review your medical and dental history and do a thorough examination of your teeth, bite, and oral tissues. You will be given a clear understanding of the orthodontic needs present, and it will be followed by a brief discussion of potential treatment options.

The examination will determine if the patient is ready for orthodontic treatment now, or perhaps should be placed on recall as we await for further growth and development. If treatment is recommended at the new patient exam, then complete orthodontic records are necessary prior to beginning treatment. These records consist of photographic images, digital orthodontic x-rays, and a 3D scan of the teeth. WIth this information Dr. Glicksman can do a complete analysis and finalize the treatment plan and treatment costs. These treatment options will be discussed at a separate consultation appointment approximatly one week after the diagnostic records. We can easily share the digital images of teeth and x-rays with your dentist, and will follow up with a report to them after the examination and records and consultation are complete. A separate fee will be charged for the diagnostic records.

If your child is not ready for treatment, we will place them in our recall system to continue to monitor their growth and development, and to determine the best subsequent time to start treatment.

Our goal is to make you feel comfortable and relaxed, and provide the best possible care for you or your child as you enter the new world of orthodontics.

Our mission statement is as follows:

To earn our patients' respect and admiration by providing superior care. To give care with humor, compassion. and a gentle hand. To create a work environment where laughter is encouraged, camaraderie is fostered, and cristicism is given and accepted with good will. To gain fulfillment from the knowledge that our patients' lives have been enhanced by our efforts. This is to have succeeded.


Please help us be prepared for your first appointment by completing the appropriate patient information and health history forms. Download the forms below to your computer, print them out, complete the forms, and bring it with to your first appointment so we can expedite your first visit!

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Click here to download it.

Office Hours




8:00 am-5:00 pm


8:00 am-5:00 pm


8:00 am-5:00 pm


7:30 am-4:30 pm





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