503.626.9700 • info@visitworldofsmiles.com • 11790 SW Barnes Road, Building A, Suite 280 Portland, OR 97225
Patient Forms
11790 SW Barnes Road
Building A, Suite 280
Portland, OR 97225
503.626.9700
For our New Patient Families, please click on the first link below to complete your family forms. If you are a Current Patient Family and have a ReCare appointment scheduled with us, please click on the appropriate link to complete your child’s Medical Health History Update and Parent Guidelines Update. When you click SUBMIT at the end of your forms, they will email directly to our Scheduling Coordinator. If you encounter any problems while filling out your forms, please call us for assistance.
We ask that you complete your patient forms at least one week prior to your appointment, so that we can begin your child’s adventure with the World of Smiles team on time!
Online Forms to Complete
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Read OnlyHealth Insurance Portability and Accountability Act
Optional InformationNitrous Oxide & Conscious Sedation Informational Guide
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Doctor ReferralsDo you have a patient referral for World of Smiles, Pediatric Dentistry? Simply click the link below and fill in the appropriate patient information. Please upload current x-rays and any patient charting information that would assist our doctors in providing the best care for your patient family. |
Questions? Contact Us for more information.
"I have hair on my fingers! I'm growing up and I have hair on my fingers now!"
~ Derek, age 3
"I like them here for helping my teeth"
~ Angelina, age 7
"(After being asked by the assistant, "Do you have any questions?) Well.... I was wondering... if I could have a puppy soon"
~ Erin, age 6
"I am going to be as sweet as a strawberry today!"
~ Pascale, age 3