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New Patient Forms


Dentist and patient point at paperwork and forms on a clipboard The following forms are provided to our patients online for download. Please print and complete the forms and bring them to your appointment.

If you have questions about any of the paperwork, please give us a call at 503-362-5019 and our staff will be happy to help you.

Patient Information And Health History


Complete these forms to provide us with contact information, medical history, and medications/allergies.



Consent For Electronic Communication


Complete this form to give us consent to allow our office to communicate through text messaging and/or email.



Privacy Policy & Privacy Notice Aknowlegement


We are committed to maintaining the confidentiality of your information. State and Federal law requires us to inform you of our policy.



Financial Policy


This form contains important information regarding our financial policies and payment guidelines.



Cancellation Policy


This form contains important information regarding our cancellation policy.



Medical Information Release


This form allows you to give us permission or not to release your medical information to a family member, friend or legal representative.

Logo for Shull Family Dentistry


Phone


503-362-5019

Hours


Mon - Thu: 8:00am - 5:00pm
Friday: Closed
Copyright © 2022 Shull Family Dentistry - Levi Shull, DMD and WEO Media (Touchpoint Communications LLC). All rights reserved.  Sitemap | Links
Shull Family Dentistry - Levi Shull, DMD, 1211 Liberty St. SE, Salem, Or 97302; 503-362-5019; shulldentistry.com; 11/26/2022; Key Phrases: dentist Salem Or;