Forms & Insurance - Chehalis WA Dentist
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New Patient Forms
We know your time is valuable. To help you save time, please complete and submit these Patient forms online safely and securely by clicking the links below.

Adult Health History Form
Child Health History Form
Office Policy and HIPPA Form
Records Release Form

If you prefer to download the Patient forms rather than submitting them online, click on these pdf links: Adult Health History (PDF), Child Health History (PDF), Office Policy and HIPPA (PDF), Records Release (PDF). Then email the forms to, fax 360-748-4132, mail PO Box 120 Chehalis, WA 98532, or bring by our office.

As a new patient entering our dental practice we will need a copy of your current x-rays and periodontal probe chart from your previous dentist, if applicable.  You can either request them yourself or fill out and sign the records release form and we can request them for you.  Please send the signed records release form to us via:  Email at, fax 360-748-4132, mail PO Box 120 Chehalis, WA 98532, or bring by our office.  Please allow at least 2 weeks before your appointment, to allow ample amount of time to retrieve all of the information.


Dr. Goldsby accepts all dental insurances, but is a preferred provider for only Delta Dental Insurance.  Please verify that your insurance will cover services at our office.  We will complete and file all insurance claims for you.

We send most claims electronically. This is safe and secure and we are HIPPA compliant when sending electronic claims. We are also able to add your x-ray and/or intraoral photo to your claim. This results in payments and feedback from your insurance carrier faster.

Dental Links
American Dental Association
Washington State Dental Association
  did you know?

• People who drink 3 or more sugary sodas daily have 62% more dental decay, fillings and tooth loss.

• The average person only brushes for 45 to 70 seconds a day, the recommended amount of time is 2-3 minutes.
- Academy of General Dentistry

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