image of Hi5 Ortho Logo
• Hillsboro: (503) 642-1535 • Portland (Cedar Hills): (503) 644-4749

slide show image Hi5 dental patient reviews 2
slide show image Hi5 dental patient reviews 2

Privacy Practices Acknowledgment

I have received the Notice of Privacy Practices and have been provided an opportunity to review it.

Parent's/Guardian First Name: *

Parent's/Guardian Last Name: *

Confidential Communications

In general, the HIPPA privacy rule gives individuals the right to request a restriction on uses and disclosures of their personal health information (PHI). The individual is also provided the right to request confidential communications or that a communication of PHI be made by alternative means, such as sending correspondence to the individual's office instead of the individual's home.

I wish to be contacted in the following manner (check all that apply)

Home Phone:

Cell Phone:

OK to leave message with detailed information

Yes No  

Leave message with call back number only

Yes No  

OK to text message

Yes No  

OK to E-mail

Yes No  

E-mail Address

OK to fax to this number

Yes No  

Fax Number:

Signature

First Name: *

Last Name: *

Date (MMDDYYYY) *

  

 

Confirmation

 
 

Please wait, it may take a moment to submit your information.

 
invisible spacer graphic invisible spacer graphic
Pham request apt button

Pham kids corner button

Pham testimonials button

Our Doctors:
Hai Pham, DMD
Jenette Intrachat, DDS
Grace Shao-Chiu Chen, DMD, MS
Jessica Irwin, DMD

TOP DENTIST, Portland Monthly

Dr. Pham was featured in Portland Monthly, chosen
as one of the Top Dentists, Pediatric Dentistry, 2011, 2012, 2013, 2014, 2015.

Proud Member
ada logo AAPD logo OAPD logo 1 PFA logo image of of dimensions 200 wide by 200 high AAP Logo image of of dimensions 300 wide by 150 high AAO Logo

Hospital Privileges
Dr. Pham has hospital privileges at:


Hillsboro

Hi5 Dentistry for Kids
- New Address!

3075 SE Century Blvd Ste 109
Hillsboro, OR 97123
Phone: (503) 642-1535
map
pham dotted line
Portland

Hi5 Dental - Pediatric Dentistry
2375 SW Cedar Hills Blvd,
Portland
, OR 97225
Phone: (503) 644-4749
map
pham dotted line
Office Hours

Monday - Thursday: 8am to 5pm
Friday: 8am to 12pm


FB btn   Visit Hi 5 Dental on Google+   Yelp Square Button for Bottom
smile reminder round

Home  | Meet The Doctors  | Dentistry for Kids  | Office Info  | Testimonials  | New Patients  | Referring Doctors  | Locations  | Hai Pham, DMD  | Jenette Intrachat, DDS  | Grace Shao-Chiu Chen, DMD, MS  | Jessica Irwin, DMD  | Insurance  | Dental FAQ  | First Visit  | Preventive Care  | Treating Decay  | Early Orthodontics  | Sports & Mouthguards  | Special Needs  | Sedation Dentistry  | Dental Emergencies  | Hi5 Dental in Hillsboro  | Hi5 Dental in Cedar Hills




Hai Pham DMD - Hi5 Dentistry for Kids | www.hi5dental.com | (503) 642-1535
2375 SW Century Blvd, Hillsboro, Or 97225