Patient Forms


Family & Cosmetic Dentistry

Susan Weinberg DMD and her staff look forward to your first visit. Please take the time to download your new patient forms and fill them out before your first visit. If you have any questions, please contact us at (503) 968-1696.

Patient Information (English)
Please complete form and bring with you on your first visit.

Información Paciente (Español)
Por favor, rellene estos formularios a cabo, de impresión, lleve con usted a su primera visita

Financial Policy Acknowledgement
Please complete form and bring with you on your first visit.

Consent For Use and Disclosure of Health Information
Please fill these forms out, print, bring with you to your first visit

Child Patient Information
Please fill these forms out, print, bring with you to your first visit


We  ♥  Referrals

Your referral of a friend or neigbor to our office is one of the finest compliments you can give us.
We welcome your friends and neighbors to become part of our family.