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Patient Forms
Dentist and patient point at paperwork and forms on a clipboard The following forms are provided to our patients online for download. Please print and complete the forms and bring them to your appointment.

If you have questions about any of the paperwork, please give us a call at (503) 668-6226 and our staff will be happy to help you.

Financial Agreement
HIPAA Notice
HIPAA Acknowledgement
Medical History
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Hours
Mon
Tues
Weds
Thur
7am to 4pm
7am to 4pm
7am to 4pm
7am to 4pm
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Mt. Hood Dental Clinic - Dr. Jeremy Kato, 39880 Pleasant St., Sandy, OR 97055-6557, (503) 668-6226, mthooddentalclinic.com, 4/1/2025, Page Phrases: dentist Sandy OR,