Insurance Follow Up

Looking for a trusted and experienced orthodontist? You're in the right place!

Dr. Tsintolas is a Specialist in Orthodontics and Dentofacial Orthopedics.

He diagnoses, prevents, intercepts, and corrects misaligned teeth and jaws.
He uses braces, Invisalign, and other appliances to improve function and enhance dental and facial aesthetics for children, teens, and adults.
He is trained and experienced in dental development. Along with the American Association of Orthodontists, he recommends an orthodontic evaluation by age 7.

Need a dental cleaning or routine dental exam? Experiencing tooth pain? A general dentist, not an orthodontist, is the right choice for you.

Need a different dental specialist? Please seek care from the appropriate provider:

periodontist (gum disease)
oral surgeon (dental surgery, tooth extractions)
endodontist (root canals)
prosthodontist (crowns, bridges, dentures)

Are you scheduling a current or returning patient or a patient that has previously visited or contacted our office?*

yesno

This form will not meet your specific scheduling needs.

Please call 301-948-7513, option 2 and let's talk!

So that we may deliver the best possible service, please provide the information requested.

Upon clicking SUBMIT, a confirmation screen will appear with a clickable link that takes you to our online orthodontic consultation scheduler.

Your Name*

First NameLast Name

Your Title*

Your Phone Number*

Please enter a valid phone number.

Your Email Address*

Confirmation Emailexample@example.com

How did you hear about Dr. Tsintolas? Please select ALL that apply.*

What is the first and last name of the patient's dentist or pedodontist?*

Dentist or Pedodontist First NameDentist or Pedodontist Last Name

What is the first and last name of the referring dentist?*

Referring Dentist First NameReferring Dentist Last Name

What is the first and last name of the referring family member?*

Referring Family Member First NameReferring Family Member Last Name

What is the first and last name of the referring friend?*

Referring Friend First NameReferring Friend Last Name

What is the NAME of your dental insurance plan? (Examples: Delta Dental, CareFirst, MetLife, etc.)*

Name of Dental Insurance Plan

I am scheduling an orthodontic consultation for:*

myselfone or more family membersmyself and one or more family members

What is your birth date?*

Your Birth Date

Please identify all family members for whom you wish to schedule a consultation. We can accommodate multiple family members with ONE consultation appointment.*

Rows	First Name	Last Name	Relationship	Age	Birth Date mm/dd/yyyy
family member #1

Rows	First Name	Last Name	Relationship	Age	Birth Date mm/dd/yyyy
family member #2
family member #3
family member #4

Please provide your information and identify all other family members for whom you wish to schedule a consultation. We can accommodate multiple family members with ONE consultation appointment.*

Rows	First Name	Last Name	Relationship	Age	Birth Date mm/dd/yyyy
Your info

Rows	First Name	Last Name	Relationship	Age	Birth Date mm/dd/yyyy
family member #1
family member #2
family member #3

Why are you seeking an orthodontic consultation? How can we help you? Please be specific.*

0/0

Upon clicking SUBMIT, a confirmation screen will appear with a clickable link that takes you to our online orthodontic consultation scheduler.

We will call you no later than our next business day to discuss and confirm your initial orthodontic consultation.

Please call the office if you don't hear from us by our next business day, 301-948-7513, option 1.

Although the scheduling module will ask for information provided on this form, PLEASE RESPOND TO ALL QUESTIONS WITHIN THE SCHEDULING MODULE.

Thank you!

This form cannot confirm or cancel appointments, send messages, request non-consultation appointments, or report urgencies or emergencies. Please call 301-948-7513, option 2 for assistance.

Online Scheduler - Orthodontic Consultation