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Haverkos Family Orthodontics Comfort Form

The form is designed for your convenience to potentially save you a visit into the office by allowing us to assess the issue and make recommendations. It also allows us to evaluate the issue so if it requires an office visit, we are able to prepare for how we can best help you when you come in. Please submit your information below.

Your info will be securely sent back to our team to evaluate. We hope to gather enough information to recommend some techniques from home or help us setup and prepare for an office visit.

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