422 E Lauridsen Blvd, Port Angeles, WA

Patient Forms

Patient Forms

For your convenience, patient registration, health and dental history and privacy forms are linked below. Before your first appointment with us, you can print and complete these important documents if you wish. We hope this makes filling out the paperwork less rushed for you and allows you to accurately inform Dr. Haworth and his staff about yourself. If you have any questions about these forms, please feel free to ask Dr. Haworth or one of his staff members about them.

Below is the Medical and Dental History form. If you are taking prescription, over-the-counter or natural medications or dietary supplements, please write down the name of the medicine and the dosage you take and bring them with you to your appointment.

Also below is the Privacy Document that all health care facilities are required to provide to patients for review and signature. It would sure make Uncle Sam happy if you would read these and sign off on them where appropriate.

Patient Registration and Medical and Dental History

Privacy Policy (HIPAA) forms

For Dental Sleep Medicine forms or information regarding the alternative to CPAP therapy please call our Sleep Coordinator at (360) 452-4749

If you can’t or do not wish to print up these forms at home please call the office at 360-457-5152 and we will send you the forms by mail.

Haworth Dentistry and Sleep Medicine

422 East Lauridsen Blvd
Port Angeles, WA 98362
Phone: 360-457-5152
Email: frontdesk@haworthdentistry.com
Monday8:00 AM - 5:00 PM
Tuesday8:00 AM - 5:00 PM
Wednesday8:00 AM - 5:00 PM
Thursday8:00 AM - 2:00 PM

Contact us to schedule a new patient examination and develop your treatment plan.