• Glendale
    • 4901 W Bell Rd, Suite 120
      Glendale, AZ 85308
  • (602) 883-7432
  • |
  • Surprise
    • 13755 N Litchfield Rd #108
      Surprise, AZ 85379
  • (623) 869-1144
Free Consult
  • Our Office
    • Meet Dr. Andy Sarpotdar
    • Meet Dr. Jenny Sun
    • Meet Our Team
    • Puggle Patrol Kids Club
    • Surprise Office
    • Glendale Office
    • Careers
    • Publications
    • Blog
  • New Patients
    • Patient Forms
    • Why Choose Us
    • Your First Visit
    • Easy Financing
    • Patient Resources
    • Reviews & Testimonials
    • Free Smile Exam
    • Free Virtual Consultation
  • Before & Afters
  • Our Treatments
    • Clear Aligners
    • LightForce Custom Braces
    • Damon Metal Braces
    • Orthodontics for All Ages
    • Emergency Care
    • Retainers
  • Contact Us
    • Free Smile Exam
    • Free Virtual Consultation
    • Patients: Refer a Friend
    • Patient Forms
    • Doctors: Refer a Patient
    • Careers
    • Review Us
Back
  • Our Office
    • Meet Dr. Andy Sarpotdar
    • Meet Dr. Jenny Sun
    • Meet Our Team
    • Puggle Patrol Kids Club
    • Surprise Office
    • Glendale Office
    • Careers
    • Publications
    • Blog
  • New Patients
    • Patient Forms
    • Why Choose Us
    • Your First Visit
    • Easy Financing
    • Patient Resources
    • Reviews & Testimonials
    • Free Smile Exam
    • Free Virtual Consultation
  • Before & Afters
  • Our Treatments
    • Clear Aligners
    • LightForce Custom Braces
    • Damon Metal Braces
    • Orthodontics for All Ages
    • Emergency Care
    • Retainers
  • Contact Us
    • Free Smile Exam
    • Free Virtual Consultation
    • Patients: Refer a Friend
    • Patient Forms
    • Doctors: Refer a Patient
    • Careers
    • Review Us
Free Consult
Glendale Office

4901 W Bell Rd, Suite 120
Glendale, AZ 85308

(623) 869-1144

Surprise Office

13755 N Litchfield Rd #108
Surprise, AZ 85379

(602) 883-7432

Patient Forms

New Patient Forms

Please thoroughly complete and submit our New Patient Form prior to your free consultation with Dr. Sarpotdar and Dr. Sun at Icon Orthodontics. If you have any questions about the form, please contact our office.

  • Online Patient Form (English)
  • Online Patient Form (Spanish)
  • PDF Patient Form
LET’S GET STARTED

Start With
A Free Consultation

We’d love to meet you! Contact us today to schedule your free consultation!

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
2 Ways to Start:

Glendale

4901 W Bell Rd, Suite 120
Glendale, AZ 85308

(602) 883-7432

Surprise

13755 N Litchfield Rd., Ste 108
Surprise, AZ 85379

(623) 869-1144

  • Our Office
  • New Patients
  • Before & Afters
  • Our Treatments
  • Contact Us

© Icon Orthodontics. All Rights Reserved.   |   View Accessibility Menu   |   Accessibility Statement   |  Privacy Policy   |   Site by Neon Canvas

  • Free Consult
  • Contact Us