New Patient

For your convenience, you may download, fill out the following forms and hit the submit button. The form automatically sends to the office:

*By completing the online form you agree that, if the office accepts insurance, you are responsible for payment of services rendered and also responsible for paying any co-pay and deductibles that the insurance does not cover. I hereby authorize McGill Orthodontics to release all information necessary to secure the payment of benefits, and I assign directly to Dr. McGill all insurance benefits otherwise payable to me. I also understand that by completing the online form I authorize an electronic signature on all insurance submissions, whether manual or electronic.


*These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo above to download.