2137 N.E. 4th Street
Bend, Oregon 97701

FORMS AND POLICIES

 

Please take a few minutes before your appointment to review and complete the appropriate forms.  You may either go on-line to complete and submit your forms; or download, print and fill out the forms to bring with you to your appointment.  The security and privacy of your personal data is one of our top concerns and we have taken every precaution to protect it.

 

Note: Established patients will need to set up a username and password to access their online account. Please allow one business day for the system to activate your online account, from the time that username and passwords are entered.

If you're having trouble opening the printable forms, please make sure you are allowing pop-ups for this page.

PATIENT FORMS

NEW PATIENT INFORMATION FORMS

EXISTING PATIENT INFORMATION FORMS

Note: A current Full Mouth Set of X-rays (less than 5 years old) and a Comprehensive Exam are required on all New Patients, before the proper cleaning appointment can be scheduled.

OFFICE POLICIES

OFFICE FINANCIAL POLICY

PRIVACY AND HIPAA PRACTICES

INFORMED CONSENT

NITROUS OXIDE INFORMED CONSENT

PERIODONTAL (GUM) DISEASE

INFORMED CONSENT

ORAL SURGERY INFORMED CONSENT

JOINT REPLACEMENT

PREMEDICATION CONSENT

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