New Patient Forms

Submit your Health History Online

We ask that you save time at the doctor’s office and fill out your registration and health history information available online.

This website is compliant with the Health Insurance Portability and Accountability Act (HIPPA). All of your personal health information is confidential, and will not be shared with anyone, aside from those involved in your treatment, without your consent.


Click here for our Child New Patient Form

Click here for our Adult New Patient Form

Click here for our HIPAA Notice of Privacy Practice Information

Contact Us

Please feel free to contact us to set an appointment.

Become Part of the American Canyon Orthodontics Family



(707) 651-9244
3419 Broadway St #1,
American Canyon, CA 94503


Mon: 9 am – 6 pm

Tues: 9 am – 6 pm

Wed: 9 am – 6 pm

Thurs: 9 am – 6 pm

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