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833 SW 11th Ave, Suite 405 Portland, OR 97205
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Patient Forms


A person signing new patient forms on a clipboard These forms are provided in PDF format for you to fill out on your computer and print, or to print and fill out by hand. We do ask that you provide an actual signature on each form that requires one, rather than typing in your name or using a digital signature.

In order to best protect the confidentiality of your personal medical information, we suggest that you bring these forms with you to your appointment or mail them to us through the US Postal Service prior to your scheduled appointment, rather than sending them to us via email.

Individual Forms for Established Patients


Health History (ages 14 and over): Download
Health History (ages 13 and under): Download
Current Medication List: Download
Pain Inventory: Download

Learn More About:
Our Staff
Our Treatment Philosophy
Your First Appointment
Client Testimonials
Our Office Policies
Contact Information

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p. (503) 228-6870
f. (503) 222-7189


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New Patient Forms

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Dr. Martha Rich, DMD | drmartharich.com | (503) 228-6870
833 SW 11th Ave, Suite 405 Portland, OR 97205
Copyright © 2018-2024 Dr. Martha Rich, DMD and WEO Media (Touchpoint Communications LLC). All rights reserved.  Sitemap
Dr. Martha Rich, DMD, 833 SW 11th Ave, Suite 405 Portland, OR 97205 : (503) 228-6870 : drmartharich.com : 2/14/2024 : Related Terms: dentist Portland OR :