Download July 15, 2005 - orthodontics

Dr. Rebecca A. Faunce, D.M.D.
www.FaunceOrthodontics.com
201 Health Park Blvd. Suite 216
St. Augustine, Florida 32086
Ph: (904) 829-8899
160 Cypress Point Prkwy, Suite D217
Palm Coast, FL 32164
Ph: (386) 446-9312
Welcome to our practice!
I would like to take the opportunity, on behalf of the entire staff, to thank you for arranging an
appointment and orthodontic evaluation in our office.
At this appointment a preliminary examination will take place to determine your orthodontic
needs. We will advise you of any existing orthodontic problem, necessary corrective treatment,
determine an estimate treatment fee range, and provide you with information on payment options.
The examination visit will take approximately 30 minutes and we will be happy to answer any
questions you may have. As a favor to your referring friend or dentist, there will be no charge for
this preliminary examination.
If it appears that orthodontic treatment is indicated, Diagnostic Records will be suggested. We
will take impressions for upper and lower study models, facial and oral photographs, a panorex
and cephalometric head pictures. These Records are necessary to properly evaluate an orthodontic
problem and plan a course of treatment. If you would like to save yourself an extra visit, please
give our office a call in advance and we will be happy to schedule your appointment to
accommodate both the exam and Diagnostic Records if our schedule allows.
Enclosed you will find a patient health questionnaire and information form. In order to best serve
your needs, it is important that we obtain an accurate history. Please complete these forms, front
and back, and bring them with you to your appointment. It is important that these forms be
completed prior to the appointment so we may have ample time in which to complete an
orthodontic evaluation. We will also need any insurance (if applicable) information to verify
coverage prior to your appointment. If your plans change and you are unable to keep this
appointment, we would appreciate a call at least one day in advance, as this time has been
reserved especially for you.
We look forward to your visit with us, and are certain that you will view your orthodontic
experience as time and effort well spent. Thank you and kindest regards.
Sincerely,
Rebecca A. Faunce, D.M.D., P.A.