Orthodontic Assessment Intake
An encrypted pre-consultation questionnaire for orthodontic practices — chief complaint, dental and medical history, previous treatment and referral details.
About this template
This template gives orthodontic practices a complete pre-assessment intake questionnaire. Patients complete it before their first consultation, giving the orthodontist a full picture before the appointment begins. All data is encrypted end-to-end in the patient's browser.
What it collects
- Patient contact and identification details
- Chief orthodontic complaint and treatment goals
- Previous orthodontic treatment history
- Relevant medical conditions that affect orthodontic planning
- Referring dentist or doctor details
- Treatment urgency preference
Encrypted by default
Orthodontic records — including photos, models, and intake questionnaires — are health data under GDPR Article 9 and the Swiss nFADP. End-to-end encryption ensures only your practice can read submissions.
How to use it
Use this template
Click 'Use template' to create a copy in your dashboard.
Customise for your workflow
Add any practice-specific questions, such as appliance preference or budget range.
Send with the confirmation email
Include the form link when you confirm the assessment appointment.
Why orthodontic practices need a structured pre-assessment intake
An orthodontic assessment consultation is a time-limited window. An orthodontist who arrives at the first appointment without a patient history has to spend the first 10–15 minutes gathering information that could have been collected in advance, leaving less time for clinical examination, treatment planning discussion, and building patient rapport. A structured digital intake form solves this: the patient provides their history at their own pace before the visit, and the orthodontist walks in already informed.
Pre-assessment intake also helps the front desk: referral source is captured for attribution tracking, urgency is flagged so appointments can be prioritised, and relevant systemic conditions (such as jaw growth patterns, syndromes, or medications affecting tooth movement) are known before the clinical notes are opened.
What an orthodontic intake form should include
A pre-consultation orthodontic questionnaire should capture both clinical and administrative information:
- Chief complaint — what the patient (or parent) wants to change
- Dental history — extractions, previous restorations, implants in the arch
- Previous orthodontic treatment — braces, retainers, orthopedic appliances, outcomes
- Relevant medical conditions — jaw joint problems, bone metabolic conditions, medications affecting orthodontic response
- Growth status — for adolescent patients, whether growth is active
- Referral source — which dentist or specialist referred the patient
Orthodontic data and compliance (GDPR, nFADP)
Orthodontic treatment records are health data and therefore subject to the strictest privacy obligations. Under Swiss law (KVG and nFADP), these records must be retained for ten years after treatment ends and stored with appropriate technical safeguards. End-to-end encryption is the strongest available control for digital forms: the intake questionnaire is encrypted before it leaves the patient's device and can only be decrypted by your practice.
Paper intake vs encrypted digital intake
| Paper intake | Encrypted digital intake | |
|---|---|---|
| Completion time | In the waiting room before assessment | At home, at the patient's pace |
| Data quality | Handwriting, omissions common | Typed, required fields enforced |
| Availability to clinician | Scanned or typed before consult | Instant, structured, searchable |
| Privacy | Physical storage, risk of loss | Encrypted, access-controlled |
Common mistakes to avoid
- Not asking about previous orthodontic treatment — retaining appliances and prior extractions change the treatment plan.
- Failing to document systemic conditions that affect orthodontic outcomes.
- Sending intake forms via unencrypted email as PDF attachments.
- Collecting intake data but never integrating it into the clinical notes workflow.
Frequently asked questions
When should the patient receive the intake form?
Send it with the appointment confirmation, ideally at least 48 hours before the assessment. This gives patients time to check their medical history and contact their GP if needed.
Is the form suitable for both adult and adolescent patients?
Yes. For minor patients, the parent or guardian completes the form. You can add a field for the guardian's name and relationship if you want to capture that explicitly.
Is this data encrypted and private?
Yes. Every answer is encrypted in the patient's browser before it is submitted. Only your practice holds the key — neither Schweizerform nor any third party can read it.
See our use case for dental and orthodontic practices, our guide to encrypted patient data collection, and our comparison of Schweizerform with other form tools for specialist clinics.