Patient Forms

SAVE TIME!

Patient Forms

Save time at the doctor's office and fill out your registration and health history information online! Take a few minutes to fill out the patient forms, and your information will be sent to our office with secure encryption.

PATIENT PORTAL

Schedule appts, Pay Bills, etc.

HEALTH HISTORY FORM

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TMJ HISTORY

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GETTING TO KNOW YOU

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PAYMENT RANGE ESTIMATES

Comprehensive Treatment - Braces
$4780 - $6980

Includes Full Mouth X-Ray and Treatment Plan

Comprehensive Treatment - Invisalign
$4780 - $6980
Limited Treatment - Invisalign
$1980 - $3980
Phase 1 Braces or Invisalign
$2680 - $3920

Ages 6 to 10

PAYMENT PLANS

The majority of patients at CCM ortho utilize interest-free payment plans for their orthodontic treatment. At Cooper, Chockley & Misner, we offer affordable monthly payment options that can be as low as $99 per month. The more insurance pays and the larger down payment you make, the lower your monthly payment.


HSA & FSA ACCOUNTS

Orthodontic treatment is eligible for payment from both HSA (Health Savings Accounts) and FSA (Flexible Spending Accounts). These accounts help you save money by reducing your taxes!


INSURANCE

Many dental insurance plans include orthodontic coverage which can help reduce both the overall cost of treatment and your monthly payment. These policies can be complicated, but our team will let you know how much money your plan will help save you at your initial consultation.

Free New Patient Exam
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No Referrals Necessary.
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