Kyle S. Wendfeldt, DDS, MS
Board Certified Orthodontic Specialist
American Board of Orthodontics
1937 Central Avenue
Ashland, Ky 41101
Phone: (606) 329-0038
Fax: (606) 329-0058
Email: info@ashlandfamilyortho.com
Office Hours:
Monday-Friday
8 a.m. to 5 p.m.
Privacy and Health Insurance and Accountability Act (HIPAA) Information
Forms
The following documents require PDF viewing software, such as Adobe Acrobat Reader
Insurance Confirmation of Eligibility for Orthodontics [PDF]
Patient Information and Med Hx Form [PDF]
Patients with Special Needs Supplemental History [PDF]
Medical Summary Report After Traumatic Accident [PDF]
Transfer Patient in Active Treatment [PDF]
Transfer Patient in Retention [PDF]
Request for Release of Patient Records [PDF]
Return Correspondence Regarding Requested Treatment [PDF]