Ortho Clinic
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  • 065 684 8704
  • SCHEDULE APPOINTMENT

Patient information forms

Click on the links below to download each form:

  1. AIB Direct Debit Mandate
  2. BOI Direct Debit Mandate
  3. Permanent TSB standing order form
  4. Patient Medical History
  5. Patient Dental History
  6. Patient Questionnaire
  • Why Choose Us
  • Consultation
  • Affordable treatment plans
  • Reward scheme
  • Your first visit
  • Do I need to be referred by my own dentist?
  • Patient information forms
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Contact Us

OrthoClinic,
Ennis, Co. Clare.

Tel: +353 65 684 8704
Email: info@orthoclinic.ie

CLINIC HOURS: Monday-Friday 9.00am - 5.00pm, Saturday by appointment