We are excited to share our new name and new 2nd location in Bedford as we grow to serve Southern NH!

Dr. Diane and her team are still here to provide the same trusted care in a fun, friendly environment that creates beautiful, confident, and healthy smiles.

Learn More

Skip to Main Content

New Patient Form

Once you've booked your first appointment at All Star Smiles Orthodontics, you'll need to fill out our new patient form to get started.

Book Consultation

Patient Information

Parent / Guardian Information

If completing this form for a minor, please complete parent / guardian information below.

Medical History

Dental History