Download PDF "*" indicates required fields Patient Name*Patient Email* I am a patient at Carroll & Sutton Orthodontics and earn reward tokens for seeing my dentist on a regular basis. Because keeping my teeth clean and healthy is such an important part of orthodontic care, we were recommended seeing you at least every 6 months for a cleaning or checkup. Thank you for completing this voucher!I have completed the following:Checkbox Dental Exam Routine Cleaning No Cavities Dentist/Hygienist Name:Appointment Date: MM slash DD slash YYYY Comments:Signature:CAPTCHA