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New Patient Forms


To prepare for your new patient appointment, please download and fill out our Medical & Dental History Form and Patient Information Form and bring a copy of each to your appointment.

To fill out these forms on your computer, please download the latest version of Adobe Reader for free at www.Adobe.com.

Additional patient forms

To Submit or Request Patient Charts and/or X-rays


To Submit Patient Records to Willamette Dental Group

To submit charts and/or X-rays to Willamette Dental Group for a patient, please mail them to our Records department at the address below or via secure email to records@willamettedental.com by clicking herePlease be sure to include the patient's first name, last name and middle initial as well as their date of birth and the date the x-rays were taken. Click here to download instructions on how to use our secure email.

Willamette Dental Group
ATTN: Records Department
6950 NE Campus Way
Hillsboro, OR 97124

Patients - please feel free to use our Request to Transfer Records to Willamette Dental Group form to assist in requesting that your previous provider send your records to Willamette Dental Group.

Disclaimer: Patient charts and/or Xrays will be kept on file for six months and then deleted if patient fails to schedule and have an appointment with a Willamette Dental Group provider.

To Request Patient Records from Willamette Dental Group

You must fill out the Authorization to Duplicate, Use, or Disclose Protected Health Information form. Click here to download. Please submit your completed form and payment to your local Willamette Dental Group office or mail to:

Willamette Dental Group
ATTN: Records Department
6950 NE Campus Way
Hillsboro, OR 97124

If you have additional questions, please email our Records Department (do not email sensitive information via this link). To email sensitive, personal information to the Willamette Dental Group Records department at records@willamettedental.com, please use our secure email by clicking here. Click here to download instructions on how to use our secure email.

These forms are available for your convenience. If you are uncertain about which form to print and use, please contact us.


Enrollment Guide*

The Willamette Dental Group enrollment guide provides you with all the information you need to know about our dental plan, including our proactive dental care approach, locations, implant services, orthodontia and much more.


*This enrollment packet is intended for Willamette Dental Group plan members that are provided dental care coverage through their employers' dental benefits plan. For information regarding individual & family plans, please click here.

Member Enrollment Application and Change of Information Form*

The Willamette Dental Group Member Enrollment Application and Change of Information Form allows you to enroll yourself and your family members in the Willamette Dental Group plan as well as change information regarding your enrollment.   Once you have completed this form, please submit it to your human resources administrator.  

*The Member Enrollment Application and Change of Information Form is intended for Willamette Dental plan members that are provided dental care coverage through their employers' dental benefits plan. For information regarding individual & family plans, please click here.

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Headquarters
6950 NE Campus Way
Hillsboro, OR 97124

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