New Patient Forms

The following forms may be printed and completed at your convenience to save you time at the evaluation and orthodontic records appointments. If you have any questions please call the office and we will assist you.

Please arrive 10 minutes prior to your scheduled appointment so we can include these forms in the record prior to Dr. Bentele seeing you.

1st Appointment (Orthodontic Evaluation)

A) HIPAA - Notice of Privacy PracticesSize
HIPAA Notice of Privacy Practices (Doc)44Kb
HIPAA Notice of Privacy Practices (Pdf)776 Kb

Need to print and sign only the last page!

B) New Patient EvaluationSize
New Patient Eval (Doc)720 Kb
New Patient Eval (Pdf)772 Kb

2nd Appointment (Orthodontic Diagnostic Records)

A) History Patient InfoSize
History Patient Info (Doc)646 Kb
History Patient Info (Pdf)726 Kb

Government Regulations InformationSize
Language Assistance Services (Pdf)445 Kb
Notice of Nondiscrimination (Pdf)925 Kb
Montebello Drive West
2575 Montebello Drive West,
Suite 101, Colorado Springs, CO 80918
Tel: (719) 268-7138
Fax: (719) 599-5107
Woodland Park
791 W Kelley's Rd,
Woodland Park, CO 80863
Tel: (719) 687-6129
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Do the right thing at the right time
with the least cost and risk.
719.268.7138 Start Your Online Consultation
Bentele Orthodontics
What our patients say...

We went to an evaluation at an orthodontist before this one and the price seemed kind of high so then I came to an evaluation here & not only was the price lower but immediately we felt very comfortable and loved the atmosphere of the office. The staff is wonderful, always on time & Dr. Bentele is a great Dr. - very knowledgeable, friendly & with excellent communication. I would recommend this practice to everyone!

We highly recommend Dr. Bentele and his practice. He is honest, friendly, skilled & timely - you name it. He and his staff are wonderful! Angela at the front desk is especially kind and helpful. Best of all - Dr. Bentele creates a wonderful outcome of beautiful teeth. I've experienced two other orthodontists with other children and Dr. Bentele definitely outshines all - in every way - even in cost! I can't speak highly enough about Bentele Orthodontics!

This office is extremely thorough in explaining all aspects of orthodontics from finances to procedures. I'm very confident in this office.

Dr. Bentele makes the patient feel comfortable with his skill and calm confidence. He's honest about the treatment needed and tries to keep the patient informed of the treatment.

Dr. Bentele is our orthodontist for our two children. He provided clear treatment plans with a practical approach. Dr. Bentele does all of the banding and bonding himself and the office appointments are appropriately scheduled. Our children get in and out quickly and the office is never overscheduled, resulting in short waits and unhurried treatment. We're very satisfied and would recommend our friends to see Dr. Bentele!

Dr. Bentele and all staff have been very professional and the cost was reasonable. The approach of not having braces on longer than necessary is one area where I have seen other children suffer (children who went to other orthodontists). The way Dr. Bentele explains what he is doing and why has been good for my daughter to learn the importance of her treatment. I appreciate Dr. Bentele's patience with us as we experienced a difficult financial time during the beginning of our process.