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(503) 477-7130

Patient Forms


Welcome to Portland Children's Dentistry! To help your visit go smoothly, we have included a few documents to gather some important information prior to your child's appointment. Please print and fill out these forms and bring them to your child's first appointment.

These forms include:
•  General Information
•  Medical History
•  Dental History
•  Financial Policies

If you have any questions please feel free to call the office or just arrive a few minutes early to fill out the forms when you get here. We will also review and have you sign our HIPAA privacy policy at the office.

We look forward to seeing you!

Click here to download New Patient Forms.

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Portland Children's Dentistry does not discriminate on the basis of race, color, religion, gender, gender expression, age, national origin, disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of volunteers and vendors, and provision of services to patients or clients. We are committed to providing an inclusive and welcoming environment for all members of our staff, volunteers, subcontractors, vendors, and clients.
Portland Children's Dentistry | www.portlandchildrensdentistry.com | (503) 477-7130
2323 NW Westover Road, Portland, OR 97210
Copyright © 2014-2017 Portland Children's Dentistry and WEO MEDIA. All rights reserved.  Sitemap | Links