Patient Forms

Please take a moment to fill out a New Patient Information Form before your first appointment.

To complete and securely submit your patient information online, fill out the Online Health History Form
To print and fill out a paper version of the form*

* If you're unable to open PDF files, you can get Adobe Reader® for free.

OrthodontiX provides quality orthodontic care for children, teens, and adults in Ellicott City, Clarksville, Columbia, and Catonsville, MD (Maryland). Drs. Hickory, Selnick & Avila specialize in orthodontics, offering digital, non-extraction treatments. Contact OrthodontiX today to schedule an appointment.

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Orthodontix

Wayne Hickory, DMD, MDS Sandra Selnick, DDS, MS Eduardo Avila, DMD, MPH

Patient Forms