One of the best ways for us to make the most of your first appointment—and save you time later—is for you to supply us up-front with information about your dental and medical history. We use the information to help us more thoroughly examine your overall physical and dental health and keep an eye out for oral symptoms that can occur as a result of other medical conditions.
We also use your patient registration information to call your insurance company ahead of time to determine the best way for you to take advantage of your benefits before you even arrive.
Forms and NoticesClick on the form names below for a PDF file of a blank form.
Please submit these forms to our office:
Patient Registration
Medical History
Dental History
Acknowledgement of Receipt of Notice of Privacy Practices
For your review and retain for your records:
HIPAA Notice of Privacy Practices
You will need the Adobe Acrobat Reader to be able to view the forms. You can download the latest version of Adobe Acrobat Reader by clicking the icon below.
Submitting Your Health InformationPlease fill out the four forms and return them to our office.
You can:
- Mail them to 2200 14th Ave. SE, Albany, OR 97322
- Fax them to (541) 928-0075
- Bring them with you to your appointment
If possible, please send us your information at least 72 hours ahead of time so that we can make the most effective use of your appointment time.
Please also read the HIPAA Notice of Privacy Practices and retain it for your records. For any questions, please call our office at (541) 928-9299 or email us.
REMINDER:
Don’t forget to bring your insurance card.
Do NOT brush your teeth 2 hours prior to arrival.
To learn more about our office and procedures, take our Virtual Tour!
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