New patient forms

To prepare for your new patient appointment, we will need some basic information about you and your medical and dental history. Your appointment reminder text/email messages will include a link to complete two online forms ahead of your appointment.  You are also welcome to download, fill out, and print the forms linked below to bring to your appointment.

• Medical & Dental History Form (English)
• Medical & Dental History Form (Spanish)
• Patient Information Form (English)
• Patient Information Form (Spanish)

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)

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