New Patients

As a premiere dentist in Southwest Portland, Dr. Beck and the entire team at South Waterfront Dental deeply care about the health and well-being of our patients. We want every visit to our waterfront dental office to be a comfortable and relaxing experience where your oral health needs are met and your expectations for quality dental care are exceeded.

To better enable us to provide the outstanding service and care you deserve, we please ask that you take a few minutes to print out and complete the forms below. Completing these forms prior to arriving at our office will help to ensure that your appointment, and those of fellow patients, starts on time and stays on schedule. If you have any questions about the forms or what it takes to complete them, please feel free to contact our office for assistance.

Full Online Forms

Note: These complete forms includes all five forms back-to-back:  Patient Information, Medical History, Dental history, Financial Policy and Dental Records Release. Please complete all pages. 

Single Online Forms

PDF Forms

Get the Quality Oral Care You Need from a Premiere Dentist in Southwest Portland

Thank you for taking the time to print out and complete the forms above. By completing these forms, you provide Dr. Back and our team at South Waterfront Dental with the information needed to develop a customized treatment plan that will perfectly meet and address your oral needs.

Each of the forms provide an important piece of the puzzle, so we please ask that you complete each one of the following:

  • New Patient: Provides us with basic information for our records, such as home and email address, phone number, and emergency contact.
  • Medical History: A comprehensive breakdown of your current medical history, including all prescription medications, medical procedures, and medical conditions you may have.
  • Dental History: A full breakdown of your oral health records, include dental x-rays, periodontal chart, and treatment history. If you don’t have this information, we are happy to contact your previous dentist to obtain your dental records.
  • Financial Policy: Outlines our financial payment policy, and serves as an agreement from doctor to patient regarding payment for all provided services.
  • Release Form: Formal written request by the patient asking their previous oral health provider to release all of their dental records.