Canby Smiles

Dental Patient Forms

We’ll need the information on the forms below prior to getting started. Please download the form, complete it and bring it to your first visit. If you are not able to complete these forms prior to your first visit, please arrive 10 minutes before your scheduled appointment.

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Patient Registration

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Dental History

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Medical History

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Financial Policy

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Insurance Policy

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Privacy Policy

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HIPAA Compliance

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Canby Smiles
General and Implant Dentistry
Joshua Wieland DMD
150 NE 3rd Avenue
Canby, OR 97013

Phone: 503-266-2629

Office Hours:
Monday: 8 AM - 6 PM
Tuesday and Wednesday: 8:30 AM - 5 PM
Thursday: 7:30 AM - 5 PM
Friday: 8 AM - 1 PM
Sat-Sun: Closed
Schedule Your Appointment ›

Dental services

All-on-4 Dental ImplantsCosmetic DentistryDental EmergenciesDental ImplantsDentures
Fixed BridgesGeneral DentistryPeriodonticsPorcelain VeneersRestoration CrownsRoot Canal TherapySedation DentistryTeeth WhiteningTooth Extractions

Dental specials

Free Implant Consultation
Dental Implant Special

Patient information

New Patient FormsFinancial Information

About us

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