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New Patient Forms

Please fill out the appropriate paperwork at your leisure.  Print one of the forms below and please bring it with you to your consultation appointment.  Thank you!

Health History Form for child under 18

Adult Health History

If you need assistance, please call us or let us know when you arrive for your appointment.

Testimonials

I can't say enough good things about Dr. Southworth and his entire staff! My two daughters needed a LOT of dental re-alignment, including headgear and recommendations for extractions and periodontal work. Dr. Southworth was one hundred percent up-front, realistic and supportive through all six years of work! He has such a caring approach with his patients, always putting them at ease with a genuine spirit, and patient, understandable explanations of all treatments and plans. I highly recommend Dr. Southworth and his caring staff for any orthodontic needs.

Karen O.

Search no further, you are fortunate to have found an orthodontist who will give it to you straight( pun intended).
Whatever your needs or goals for your child, Dr. Southworth can assist you in understanding all of your options- including the option to not get braces! He is not a salesperson but an extremely well educated and experienced Orthodontist who will offer you and your child a caring and well supported consultation. His inclusion of your child in this process is perfection.
If you do proceed with braces, a kind and supportive team will make the entire process a walk in the park. I had two children who had very different needs. Both had incredible outcomes.
In terms of value, his pricing cannot be beat. There is a well detailed, comprehensive arrangement laid out before services even begin- this means NO SURPRISES! Payment was easy with an extremely reasonable payment plan.
Having his office so convenient is vital for ongoing care and his team makes it incredibly easy to schedule, interface with your regular dentist, and manage all the intricacies of any insurance you may have. They are a pleasure to deal with and I can honestly say after dealing with them for many years, every interaction was a joy.
Choosing the right fit for your orthodontist is critical and we are so blessed to have Dr. Southworth in our area. Some of my friends were not as fortunate and in the end paid more in time, money and stress across the board.
If you are able to utilize his services, you will be more than pleased with both the process and the outcome!

Mary L., Sterling

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