Download Patient Forms

For your convenience, our patient forms are available for download (pdf format). Simply print and fill out the appropriate forms below and bring them with you to your next appointment. To download Adobe’s free PDF reader, click here.

NOTE: All patients need the Hippa consent form; print both pages under adult or child forms.

Hippa Consent Form


Adult Forms


Child Forms


Medical History



OUR OFFICES

PENDLETON

  • 2237 SW Court Avenue
  • Pendleton, OR 97801
  • (541) 276-7819
  • FAX: (541) 278-2563
  • TOLL-FREE: (800) 962-7038

HERMISTON

  • 1060 W Elm, Suite 135
  • Hermiston, OR 97838
  • (541) 567-2662
  • American Association of Orthodontists
  • American Dental Association