Greeley, CO (Colorado) Orthodontist Gary J. Kloberdanz

Please help us be prepared for your first appointment by completing this Patient Information and Medical History form. Download the form below (in either Word or PDF format) to your computer, print it out, complete the form, and bring it with you to your first appointment.

Adult Patient Information [Word format] [PDF format]
Child Patient Information [Word format] [PDF format]
Privacy Acknowledgement [Word format] [PDF format]
Notice of Privacy Practices [Word format] [PDF format]

If you're unable to read PDF files, you can download Acrobat Reader free from Adobe.
[Download Acrobat Reader]


GREELEY ORTHODONTIC CENTER \| 2021 CLUBHOUSE DR. SUITE 110 \| GREELEY, CO 80634 \| 970.330.2500