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Your Medford Dentist

Patient Information Forms

Two Easy Ways To Get Your Paperwork Done Before Your Appointment

Easy

Spend less time in the office! For added convenience you can fill out your forms here online wherever you want or download, print, and complete your forms at your home or office and bring with you to your appointment.


Option A:  FILL ONLINE 

  • Patient Information
  • Insurance Information
  • Health History
  • Noticy of Privacy Practices
  • Acknowledgement of Receipt of “Notice of Privacy Practices”
  • Medical Information Release

Option B:  DOWNLOAD, PRINT and COMPLETE your forms by hand and bring them in with you to your appointment at our Medford dental offices.

Patient Information Form

Click on the image to download a PDF of the Patient Information Form.

In-House Dental Plan Enrollment Form

Click on the image to download a PDF of the In-House Dental Plan Enrollment.

Medical Information Release Form

Click on the image to download a PDF of the Medical Information Release Form.