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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.

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Mon - Thu: 8:00am - 5:00pm
Friday: Closed
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Shull Family Dentistry - Levi Shull, DMD, 1211 Liberty St. SE, Salem, Or 97302 ^ 503-362-5019 ^ ^ 7/11/2024 ^ Page Terms:dentist Salem Or ^