New Patient Forms

For your convenience, we’ve uploaded digital versions of all our new patient forms to our website! In order to make your first visit to Eugene Family Dental go as smoothly as possible, we recommend filling these forms out at home and bringing them to your first appointment. Just download them, print them, fill them out, and bring them with you, and you’ll be one step closer to great dental care!

  • Dental Records Release Form – This form is required to allow our office to directly request copies of your personal dental records from your previous dentist.
  • Medical History Form – This is form is used to conveniently record all of your pertinent medical history. It is necessary for all new patients and may be requested as an update for existing patients.
  • HIPPA (Privacy of Personal Data) – This form is to acknowledge that you understand to what extent your private personal and medical data could be utilized and under what circumstances it may be shared with other agencies.
  • Informed Consent Form – This form is provided to help patients understand the implications of any dental procedure performed in our office and will be signed prior to all treatment.
  • Oral Surgery Informed Consent Form – This form is to acknowledge informed consent specifically for any oral surgery/extraction procedure completed and will be signed prior to any related procedure.
  • Teeth Whitening Informed Consent Form – This form is to acknowledge informed consent specifically for teeth whitening procedures provided by our office and will be required prior to any related procedure.

If you are having trouble opening these files, you may need to download and install Adobe Reader.

We’re here to help, so don’t hesitate to call with any questions! You can reach us at 541-484-1235 or by filling out our online contact form. We hope to see you soon!

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