Dental appointment request form
Patients request a check-up or treatment with their reason for visit, preferred day and time of day.
Orthodontic consultation request form
An orthodontic enquiry can concern a first discussion of braces, questions about clear aligners or a treatment already in progress. This template lets the person contacting the clinic choose a topic and request a consultation time. It can be used by a patient or a parent or carer, without collecting a child's identifying details. Treatment interests and experience are optional. An orthodontist discusses the individual situation; the form does not recommend an appliance or estimate treatment duration.
Opens as an editable form in your dashboard. If you're not signed in yet, you'll sign in or create an account first.
This template is a starting point, not legal advice. Check the questions, the consent text and how long you keep the answers against the data protection rules that apply to your practice.
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What's in this template
Every field can be renamed, reordered, made optional or removed in the form builder.
- Full nameShort answer · Required
- Phone numberPhone · Required
- EmailEmail · Optional
- Who is the consultation for? (optional)Single choice · Optional
- What would you like to discuss? (optional)Dropdown · Optional
- Questions or previous orthodontic experience (optional)Long answer · Optional
- Preferred dateDate · Required
- Preferred time of dayDropdown · Required
- ConsentCheckbox · Required
How to use this template
Open it in your dashboardSelect “Use this template”. If you don't have an account yet, sign up first; the form opens right after.
Make it yoursChange the questions, options, colours and the thank-you message in the form builder, then save.
Share it and get responsesShare the form's link or link to it from your website. Each response is emailed to you and saved in your dashboard.
Tips for this form
- Offer only the orthodontic consultation topics your clinic handles.
- Ask a parent or carer to provide their own contact details for an initial orthodontic enquiry.
- Discuss orthodontic records through the clinic's chosen process after reviewing the request.
Running a business like this? See how Zotview sets up the website, booking and forms for Clinics and practices.
Zotview for Clinics and practicesQuestions about this template
Can a parent request an orthodontic consultation?
Yes. The person completing the form can say the visit is for a child or someone in their care and use their own name and contact details.
Does choosing clear aligners mean they are suitable?
No. The selection is a discussion topic. The orthodontist assesses the situation and discusses options during the consultation.
Are scans or dental photographs needed to send the request?
No. This template has no uploads. The clinic can explain its records process after reviewing the enquiry.
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Zotview form builder
Start with this form, change anything later
The template opens in the form builder, where you can edit every question and choose who receives the responses.