Forms & Insurance

For over 30 years, Dr. Piper has provided braces for kids and adults in the Memphis area. As one of the leading orthodontists in Memphis and Cordova, Dr. Piper’s goal is to create more than beautiful smiles—he provides quality orthodontics in a professional and caring atmosphere. We strive to assist all of our patients in achieving a lifetime of oral health habits through education, treatment, and prevention.

For more information on your first few orthodontic visits, see What To Expect.

Please assist us by providing the following information at the time of your first orthodontic visit:


You may access the following form to assist us with your care. Please print and fill out the desired form, then bring it to your appointment.

Adult New Patient Forms * (PDF format)
Child New Patient Forms * (PDF format)


Whether you want braces for adults or braces for kids and you live in the Memphis area, we will do our best to make orthodontics affordable for you. The result of orthodontic treatment can last a lifetime; therefore, it may be wise to think of it as an investment. Every case is different and you will receive an estimate in writing before any work is begun. The quoted fee will be good for 30 days.

We offer a variety of payment options to meet your needs, including credit card payments, bank drafts and financing options. If you have any questions about financing or payment, ask us! We will thoroughly explain your choices and work hard to accommodate your needs.

Cash, checks, automated bank draft, Visa, MasterCard, and American Express.


If your insurance covers orthodontic treatment, you receive the benefit of reduced costs. Many insurance policies have a lifetime-orthodontic benefit that is distinct from regular dental insurance. Insurance policies vary, so we review your insurance to determine the appropriate course of action. Once treatment starts, we will file your claims.

Please complete the insurance questions on our questionnaire so we can file with your insurance. Orthodontic insurance is a benefit for you or your child, so if your benefits change during the course of treatment you remain accountable for all charges.


Sign up for our newsletter.