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    • Home
    • about us
    • FAQ
    • VOLUNTEERING
    • PATIENT FORMS
    • ORTHODONTIC EMERGENCY
    • Contact Us

  • Home
  • about us
  • FAQ
  • VOLUNTEERING
  • PATIENT FORMS
  • ORTHODONTIC EMERGENCY
  • Contact Us

COVID-19 consent form (required)

Please complete this form no later than the day before your appointment (only needs to be completed

covid-19 consent click here (ENGLISH)

COMPLETE ESTE FORMULARIO A MÁS TARDAR EL DÍA ANTES DE SU CITA (SOLO DEBE COMPLETARLO UNA VEZ).

covid-19 consent click here (SPANISH)

volunteer vouchers

Volunteer hours voucher (pdf)Download

electronic volunteer voucher

The link below can be used by volunteer coordinators to fill out volunteer vouchers.

ELECTRONIC VOUCHER

EXAM forms (electronic)

MEDICALHISTORY/HISTORIAL MEDICO

PRIVACY PRACTICES/AVISO DE PRÁCTICAS DE PRIVACIDAD

PRIVACY PRACTICES/AVISO DE PRÁCTICAS DE PRIVACIDAD

Please complete this form prior to your initial exam. Just click on the link below, fill out the form, then press submit. 

MEDICAL HISTORY/HISTORIAL MEDICO

PRIVACY PRACTICES/AVISO DE PRÁCTICAS DE PRIVACIDAD

PRIVACY PRACTICES/AVISO DE PRÁCTICAS DE PRIVACIDAD

PRIVACY PRACTICES/AVISO DE PRÁCTICAS DE PRIVACIDAD

Please read our privacy practices (see below) and complete the form below prior to your initial exam. Just click these link to complete the form electronically. 


PRIVACY RECEIPT/RECONOCIMIENTO DE RECIBO DE AVISO DE PRÁCTICAS DE PRIVACIDAD
PRIVACY PRACTICES (pdf)Download
RECONOCIMIENTO DE RECIBO DE AVISO DE PRÁCTICAS DE PRIVACIDAD (pdf)Download

INITIAL RECORDS (electronic)

INFORMED CONSENT, PHOTO RELEASE, AND PATIENT CONTRACT*

Please read the informed consent (see download below) and e-sign the form by clicking INFORMED CONSENT below. (*IF THE PATIENT IS UNDER 18 YEARS OF AGE, THE CONTRACT NEEDS TO BE SIGNED BY THE PATIENT AND THE PARENT). 

INFORMED CONSENT - click to complete
READ: Informed Consent Document (pdf)Download

Registros de ortodoncIA (electronicA)

CONSENTIMIENTO INFORMADO, PHOTO RELEASE, Y CONTRATO DEL PACIENTE*

Lea el consentimiento informado de AAO (ver descarga a continuacion) y firme electrónicamente el documento a continuación (*SI EL PACIENTE ES MENOR DE 18 ANOS, EL CONTRATO DEBE SER FIRMADO POR EL PACIENTE Y EL PADRE).

CONSENTIMIENTO INFORMADO
Consentimiento Informado Documento (pdf)Download

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541-771-1765          569 NE Clay Ave         Bend, OR  97701

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