Patient Forms

At Stones Family Dental, in Salem Oregon, our goal is to provide you with the highest levels of quality dental care. We are committed to your comfort and are dedicated to improving your smile. Need Patient Forms? For your convenience we have added our new patient information forms online so you can print and complete them in the comforts of your own home. Doing so in advance will allow us to serve you better during your initial visit.

Patient Information Form

Print and complete this form to provide us with personal, family and emergency contact information.

Medical History Form

Print and complete this form to provide us with information pertaining to your medical history and current medications.

Insurance and Payment

This document contains information pertaining to insurance benefits and how Stones Family Dental works with you and the insurance provider to provide your care.

Financial Policy

At Stones Family Dental, we offer several payment options for your convenience. This form contains important information regarding our financial policies and payment guidelines.

HIPAA Notice and Consent

Stones Family Dental is committed to maintaining the confidentiality of your
personal, financial, and health information. State and Federal law requires us to inform you of our policy and practices as long as we provide you services.

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