Patient Forms

A person signing new patient forms on a clipboard These forms are provided in PDF format for you to fill out on your computer and print, or to print and fill out by hand. We do ask that you provide an actual signature on each form that requires one, rather than typing in your name or using a digital signature.

In order to best protect the confidentiality of your personal medical information, we suggest that you bring these forms with you to your appointment or mail them to us through the US Postal Service prior to your scheduled appointment, rather than sending them to us via email.

For New Dental Patients

Ages 18 and over: Download
Ages 14 to 17: Download
Ages 13 and under: Download

For New TMJ Dysfunction Patients

Ages 18 and over: Download
Ages 17 and under: Download

For New Obstructive Sleep Apnea Patients

Ages 18 and over: Download
Ages 17 and under: Download

Individual Forms for Established Patients

Health History (ages 14 and over): Download
Health History (ages 13 and under): Download
Pain Inventory: Download
Sleep Assessment: Download

Learn More About:
Our Staff
Our Treatment Philosophy
Your First Appointment
Client Testimonials
Our Office Policies
Contact Information

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p. (503) 228-6870
f. (503) 222-7189

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New Patient Forms

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Dr. Martha Rich, DMD | | (503) 228-6870
833 SW 11th Ave, Suite 405 Portland, OR 97205
Copyright © 2018-2020 Dr. Martha Rich, DMD and WEO Media (Touchpoint Communications LLC). All rights reserved.  Sitemap | Links