New Client Forms

At Kieffer Orthodontics we are dedicated to providing our patients with the highest quality of care coupled with flexible financial options to meet your needs. Your initial consultation with Dr. Kieffer is complimentary. If you decide to move forward with orthodontic treatment, payment arrangements will be arranged to suit your needs. For your convenience, we offer a courtesy for payment in full at the start of treatment as well as in-house, interest-free payment plans and interest-free financing through Chase Financial. We accept Visa, Mastercard, American Express and Discover credit cards.

We are happy to verify your orthodontic insurance benefits and bill your provider as a courtesy to you. Your insurance provider will reimburse you directly with any orthodontic benefits you may have. We do not guarantee your orthodontic insurance benefits or payment from your provider.

Click on the following link to download your pdf document: NEW CLIENT FORM