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Patient Forms

You may access the following forms to assist us with your care. Please fill out the form online and print to bring to your appointment or cliick the submit option to email the form to us.


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I was only 10 years old when I first got my braces. I wanted them more than anything. Even at a young age, I felt as if I couldn't smile or be happy because my teeth were the way they were: Messed up. I was the type of girl who loved taking pictures and having fun, but my teeth got in the way of that. Luckily my mom made an appointment at Dr. Justice's office. It was almost like Christmas to me. Soon after getting the braces on, I felt relieved and happy again. I knew with just a matter of time, I'd have a smile like the ones on the cover of a magazine. Even through the pain and misery those things put me in, I kept my head up and dealt with it because I knew this is what I had to go through in order to have a pretty smile. I had my braces for a total of 4 years and my smile is better than it's ever been. Thanks to Dr. J and the crew, I couldn't be happier!

-Emily Verdin, Age 16