• Charlotte Office
  • 704-334-7204
  • |
  • Indian Trail Office
  • 980-202-7444
  • |
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Free Consult
  • New Patients
    • Treatment Costs & Insurance
    • Patient Forms
    • Free Consult
    • Online Smile Assessment
  • About Us
    • Meet Dr. Lindsey Koerich
    • Meet Dr. Leo Koerich
    • Publications
    • Charlotte Office
    • Indian Trail Office
    • Careers
    • Blog
  • Our Treatments
    • Invisalign
    • InBrace Hidden Treatment
    • Metal Braces
    • Clear Braces
    • Orthodontics for All Ages
  • Contact Us
    • Free Consult
    • Online Smile Assessment
    • Doctor Referrals
    • Review Us

Charlotte Orthodontic Office

7922 Rea Rd. A,
Charlotte, NC 28277

704-334-7204

Indian Trail Orthodontic Office

6437 Old Monroe Rd., Suite H,
Indian Trail, NC, 28079

980-202-7444

Patient Forms

Streamline Your First Visit

If you have the chance, please fill out the patient history and HIPAA forms before your first appointment. This helps make your first visit with us streamlined and easy!

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HIPAA Notice of Privacy Practices
Patient Referral
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Koerich & Case Forms

Patient/Health History Form
Notice of Privacy Practices
HIPAA Form
COVID-19 Health Form

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Charlotte Orthodontic Office

7922 Rea Rd. A,
Charlotte, NC 28277

704-334-7204

Indian Trail Orthodontic Office

6437 Old Monroe Rd., Suite H,
Indian Trail, NC, 28079

980-202-7444

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