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About Us
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Treatment Options
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Technology
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Our Locations
Racine
New location coming to the Racine area soon!
Coming Soon
Complete online
Select the form that applies to you.
Choose the child or adult form below. Completing these before your first appointment helps us prepare your records and spend more time on what matters — your smile.
For patients under 18
Child Patient Form
For children and teenagers
Patient & parent/guardian information
Medical & dental history
Insurance information
Consent & authorization
For patients 18 and over
Adult Patient Form
For adult patients
Patient contact information
Medical & dental history
Insurance information
Consent & authorization
Why complete forms in advance
Save time. Start faster.
Completing your forms before your appointment helps us prepare and means you spend less time on paperwork and more time with the doctor.
Less waiting at the office
Skip the clipboard. Your information is ready when you arrive so we can get started right away.
More accurate records
You can take your time at home — no rushing through forms in a waiting room.
Secure & confidential
All forms are submitted securely. Your personal and medical information is kept strictly confidential.
Questions about your forms?
If you're unsure which form to complete, have trouble submitting, or need assistance, just give us a call. We're happy to help.
Two convenient locations
Come visit your Smile Squad.
Pleasant Prairie & Kenosha
View location →
Oak Creek
View location →
Find us
Two convenient locations.
Serving Kenosha, Pleasant Prairie, Oak Creek, and all of southeastern Wisconsin.
Pleasant Prairie & Kenosha
Pleasant Prairie Office
Oak Creek
Oak Creek Office
ValeriOrthodontics
Marquette-trained orthodontists serving Kenosha, Pleasant Prairie & Oak Creek, WI. Braces, Invisalign & Angel Aligners for every smile.
© 2026 Valeri Orthodontics. All rights reserved.