Online Forms

Online Patient Registration

You may preregister with our Bend OR oral surgery office by filling out our secure online Patient Registration Form . After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature.  The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

West Office

Online Patient Registration

East Office

Online Patient Registration

TMJ Evaluation Online Form

If you are coming to our office for a TMJ consultation please fill out our secure online  TMJ Evaluation Form . After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

West Office

TMJ Evaluation Form

East Office

TMJ Evaluation Form

Patient Motivation Questionnaire

If you are coming to our office for an Orthognathic consultation or desire a change in your facial appearance please fill out our secure online  Patient Motivation Questionnaire .  After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

West Office

Patient Motivation Questionnaire

East Office

Patient Motivation Questionnaire

Accident Information Online Form

If your consultation with our office is due to an accident, please fill out our secure online  Accident Information Form . After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

West Office

Accident Information Form

East Office

Accident Information Form

Patient Survey Form

Click here to complete our online survey form.