Patient Forms

Save Time at Your First Visit

Save time at your first appointment and fill out your forms online.

Fill out your paperwork ahead of time to save time when you visit our office.

Enroll or update auto payments with this online form.

Please review this notice describing how medical information about you may be used and disclosed and how you can get access to this information.

This consent is for braces removal.

This consent is for younger children in their first of two phase treatment.

Patient's Full Name(Required)

Parent / Guardian Name

Email(Required)

Phone(Required)

Date of Birth

Office Location

Messaage(Required)

Text Opt-In(Required)

By checking this box, I agree to receive texts and phone calls from Meyer & Dana Orthodontics at this mobile number.

CAPTCHA

This field is for validation purposes and should be left unchanged.

Rapid City, SD

Spearfish, SD

Pierre, SD

Rushmore Crossing