Beyond Your Smile


All new patients are required to fill out a new patient form. You may complete this during your visit, or fill it out before your appointment by downloading it by clicking on the button below.
Read through the information provided below from Beyond Your Smile for useful tips on how to maintain oral health immediately after beginning your orthodontic treatment.

New Patient Form

COVID Screening


Please read the information below carefully. If not followed, your treatment may be negatively impacted; constantly spending time repairing broken braces delays treatment time.

  • NO gum or sticky candies, this includes (but not limited to):Gummy Bears, Gummy Worms, Gummy Vitamins, Airheads, Starburst, Now and Laters, Swedish Fish, M&M’s, Fruit By The Foot, Fruit Roll-Ups, Fruit Chews, Laffy Taffy, Warheads, Jawbreakers, Sour Gummy or Sour Patch Kids!

  • NO bagels (unless cut up into very small pieces).NO pizza crust, no thick pan pizza (unless cut up into very small pieces).NO submarine sandwiches.

  • NO corn on the cob (unless cut off the cob).NO raw carrot or celery sticks.

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    NO popcorn, peanuts, pretzels, Doritos, or granola bars.NO cape cod chips.

  • NO ice cubes / frozen foods (like popsicles).


The foods listed below may be eaten, provided the stipulations are followed:

    Meat removed from the bone (chicken wings, boneless spareribs, pork chops). Do not bite directly into the bone.
    Fresh vegetables and fruits – Provided they are sliced as thin as possible.
    Steak – Provided it is cut up into very small pieces.
    Soda – Should be restricted (sugar free or not) as the acids contained in them do cause decay and breakdown of the cement used to bond the braces to the teeth.

*Phosphoric acid is the primary ingredient in soda that is potentially destructive


  • medicine and healthcare 02 final

    NO biting fingernails, pens, pencils or erasers.

  • NO picking at the braces or wires.

If brackets break, please contact the office immediately to make arrangements for repairs. This constitutes a semi-emergency visit, and should not wait for monthly appointments. Also, broken brackets sometimes take extra time to repair, so an appropriate time must be scheduled in advance.

Section 1557 of the Patient Protection and Affordable Care Act

OCR – Office for Civil Rights

Beyond Your Smile and its employees follow the rulings of Section 1557 of the Patient Protection and Affordable Care Act and its nondiscrimination policies as outlined below.
Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. Section 1557 builds on long-standing and familiar Federal civil rights laws. It extends nondiscrimination protections to individuals participating in:
· Any health program or activity any part of which received funding from HHS
· Any health program or activity that HHS itself administers
· Health insurance Marketplaces and all plans offered by issuers that participate in those Marketplaces.
If you believe you have been discriminated against on one of the bases protected by Section 1557, you may file a complaint with OCR.
A full text version of Section 1557 can be found in the Federal Register.