Patient Forms

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Thank you for choosing Niagara Peninsula Orthodontics! Dr. Neeraj Pershad offers not only individualized orthodontic treatment to patients of all ages, but also has the experience to match. Our goal is to give every patient a beautiful smile, and we’ll work closely with you to find a financial plan that’s right for you. We have four office locations in the Niagara Peninsula in Niagara Falls, St. Catharines, Fonthill, and Beamsville for your convenience. 

When you visit us at one of our offices for your initial consultation appointment, we will ask that you complete your new patient forms. Because your convenience is our top priority, we’ve also uploaded these forms below so you can download and complete them before your first visit. By bringing these completed forms with you, you’ll be able to save yourself a bit of time on the day of your first visit.


These documents are in PDF format. If you’re unable to read PDF files, you can download Acrobat Reader free from Adobe.

In addition to completing these forms, we ask that you bring a form of identification, as well as your insurance information. This will allow our staff members to determine if we accept your benefits at our office. If not, we have plenty of other financial and payment options available to you.

If you have any questions while you’re completing these forms, feel free to give us a call and one of our staff members will be happy to assist you.

Contact Your Niagara Peninsula Orthodontic Provider!

If you have any questions about our patient forms, our services or anything else, you can contact us at any of our four office locations. For appointment scheduling, you can complete our online appointment request form or simply call us at one of our offices. For phone numbers for each office, feel free to visit their corresponding appointment page. We look forward to meeting you soon!