To prepare for your new patient appointment, please download and fill out the required forms below. Please print and bring them to your appointment to simplify the registration process.

Medical & Dental History Form (English)

Medical & Dental History Form (Spanish)

Patient Information Form (English)

Patient Information Form (Spanish)

To fill out these forms on your computer, please download the latest version of Adobe Reader for free at www.Adobe.com.

Additional patient forms

These forms are available for your convenience. If you are uncertain about which form to print and use, please contact us.

• Non-Guardian Release Form
• Willamette Dental and Affiliates Corporate Privacy Statement
• Notice of Privacy Practices
• Authorization for Use and Disclosure of Protected Health Information
• Authorization to Duplicate Protected Health Information
• Summary of Exclusions and Limitations related to Medical Necessity Decisions (Washington)