Office Forms

Please Fill out the following ONLINE forms before your first visit so we may serve you better and faster. When you finish filling out these forms, be sure you click on the "CLICK HERE" at the end to confirm you have just finished the entry of the medical questionnaire. Your filled out forms will go directly to our secure HIPAA compliant server / software system.

For Patients with Sleep Apnea or Snoring

For Patients with Orthodontic Problems

For Patients with TMJ / TMD / Temporomandibular Jaw Joint Disorders

For Patients with Sleep Apnea or Snoring

 

 

 

Ortho DW

Quick Links:
Contact Details:
125 Alison Drive
Suite 1-A Medical Arts Building
Alexander City, Alabama 35010
phone – 256-234-6353
fax – 256-234-6713
Monday thru Thursday 8:00 AM - 4:00 PM (by appointment)
email – info@drharrell.com