Patient Registration Form

Thank you for choosing Orthodontic Specialists of Tucson. In preparation for your upcoming appointment, we would like to assist in streamlining your registration process by offering an online solution. Please fill out the Online Patient Registration by clicking on the button below. Upon completion, click on the SUBMIT button. Your Patient Registration will be sent automatically and securely to our office. Any necessary signatures will be captured when you arrive for the appointment. Please make sure to bring your insurance cards (both medical and dental), a valid picture I.D., and any necessary referrals and/or x-rays.


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Dr. Daniel Pearcy & Dr. Mittida Raksanaves your Tucson Orthodontists provide Orthodontic Treatment for Teens, Children & Adults including Braces, Lingual Braces, Invisible Braces, Clear Aligners, Gold Braces, Herbst, Invisalign, Space Maintainers, Headgear, & Retainers



1320 West Ina Road
Tucson AZ 85704




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