To request a copy of your patient records from Willamette Dental Group, please follow these steps:

Step 1

Complete this form, including your signature, to authorize us to duplicate your protected health information.
To sign the form, please download and add an Esignature in Adobe Acrobat or print, sign, and scan the signed document to us.

Step 2

Send your completed authorization form in ONE of the following ways: 

Option #1: Secure Email Portal

The secure email portal is available to send requests in an encrypted format to protect patient health information.

Option #2: US Postal Mailing Address

Mail your completed form and payment to:

Willamette Dental Group
ATTN: Records Department
6950 NE Campus Way
Hillsboro, OR 97124

Option #3: Fax

Fax your completed form and payment to 503-952-2601

Option #4: In-Person

Visit any of our offices Monday through Friday from 7am – 5:30pm to hand in your completed form and payment.

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These forms are available for your convenience. If you are uncertain about which form to print and use, please contact our Records Department (do NOT send sensitive information through this link). The department is open Monday through Friday from 9am – 4pm.

We adhere to the Dental Practices Act Standard to process requests received. Estimated turnaround time is 5 business days for electronic requests and 10 business days for printed requests. We do not offer rush processing.