New Patient Form | Shafer Smiles

CHAMPAIGN & MAHOMET, IL'S
FAVORITE ORTHODONTIST

For Questions, Text 217-356-9595

CHAMPAIGN & MAHOMET, IL'S
FAVORITE ORTHODONTIST

For Questions, Text 217-356-9595
CHAMPAIGN & MAHOMET, IL'S
FAVORITE ORTHODONTIST
For Questions, Text217-356-9595

New Patient Form

You may access the following patient form to assist us with your orthodontic care. Please print and fill out the below form. You can either email it to us at info@shafersmiles.com or bring the form with you for your appointment. You will need Adobe Reader to electronically fill out the form and submit by email to our Homewood, IL orthodontics office. Download Adobe Reader here