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  • About Us
    • Meet Dr. Periago
    • Meet the Team
    • Reviews + Testimonials
    • Visit Our Office
      • Corydon
      • Floyds Knobs
      • New Albany
    • Blog
    • Careers
  • New Patients
    • Why Choose Us
    • Your First Visit
    • Free Consult
    • Insurance & Finances
    • Patient Forms
    • Pay My Bill
  • Our Treatments
    • Invisalign
    • Invisalign for Teens
    • Metal Braces
    • Clear Braces
    • Indirect Bonding
    • Ortho for All Ages
    • Orthodontic FAQs
    • Ortho Emergencies
  • Before & Afters
  • Contact Us
    • Free Consult
    • Virtual Consult
    • Patients: Virtual Visit
    • Refer a Friend
    • Review Us
    • COVID-19 Office Update
    • Pay My Bill
Free Consult
  • New Albany

    3007B Charlestown
    Crossing Way
    New Albany, IN 47150
    812-944-5595

  • Corydon

    1985 Edsel Ln NW,
    Corydon, IN 47112
    812-738-7273

  • Floyds Knobs

    800 Highlander Point
    Dr. #201,
    Floyds Knobs, IN 47119
    812-923-9877

Patient Forms

Save Time at Your First Visit

Please download these forms and bring them with you to your first visit to keep your appointment running on time.

English - Digital

Adult Health History Form Child Health History Form Tell Us About You Electronic Payment Authorization COVID-19 Screening Questionnaire

English - PDF

Adult Health History Form Child Health History Form Tell Us About You Electronic Payment Authorization COVID-19 Screening Questionnaire

Spanish - PDF

Formulario de antecedentes médicos para pacientes adultos Formulario de antecedentes médicos para pacientes menores de 18 año

Start Your Journey to Your Best Smile Today

It’s time to feel confident about your unique smile. Get started with your free consultation exam from Periago Orthodontics.

Periago Orthodontics Logo

New Albany

3007B Charlestown
Crossing Way
New Albany, IN 47150
812-944-5595

Corydon

1985 Edsel Ln NW,
Corydon, IN 47112
812-738-7273

Floyds Knobs

800 Highlander Point
Dr. #201,
Floyds Knobs, IN 47119
812-923-9877

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