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New Patient Forms

Take your first step toward designing your perfect smile alongside Dr. Ben and his staff. Feel the confidence you’ve only dreamed of with a dazzling smile. Fill out this new patient form before your first visit to get started as soon as you arrive.

Download the documents below, or click here to get a zip file with all of the forms.

Health History

Notice of Privacy Practices

Acknowledgement of Receipt of Privacy Practices

New Patient Info

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6095 South Fashion Blvd, Suite 220, Murray, UT 84107 USA
Dr. Ben Neibaur Murray UT, family orthodonic therapy. (801) 269-0303
155 East 13800 South, Draper, UT 84020 USA
Dr. Ben Neibaur Draper UT, family orthodonic therapy. (801) 269-0303
228 West 200 South, Suite 1A, Kamas, UT 84036 USA
Dr. Ben Neibaur Kamas UT, family orthodonic therapy. (801) 269-0303