Patient Forms

Please download, print and fill out these forms and bring them with you to your appointment. Forms provided in Word and PDF formats.

Medical History:


Patient Registration Form:
 


Smile Evaluation:
 

Financial Policy:
 

Acknowledgement of Reciept of Notice of Privacy Practices:
 

Please read this form before your appointment.

Notice of Privacy Practices:
 

6333 SW Macadam Ave Ste. 107 • Portland, OR 97239 • Ph: 503-977-3400 • Fax: 503-977-3407 • Email  Site made by: FOTG Films and Multimedia