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Patient Forms

We want to welcome you to the Smiles by Design Orthodontics family!

We are glad that you are interested in becoming a patient of Dr. Stephane Dieudonne’s Pembroke Pines, FL dental practice. New patients are always welcome here. Everyone at Smiles by Design Orthodontics is committed to making your visits pleasant and stress-free. You can count on our friendly, highly experienced staff to always provide the highest standard of dental care in a clean, state-of-the art environment. Your comfort is our top priority.

We look forward to seeing you soon!

Dr. Stephane Dieudonne and the Smiles by Design Orthodontics team


Click below to download New Patient Registration Materials


Informed Consent 

Adult Medical History

Child Medical History