Patient Information

Proudly Serving Patients in Portland, TX & Beyond

At The Dental Place, our team offers reliable, professional, family-friendly dental care in Portland, TX. Our dentist and staff is committed to providing each patient with care specific to their individual needs and wants. We are dedicated to providing you and your family with top-notch general and cosmetic dentistry. We want our patients to feel comfortable about coming to us for their oral health needs, so we ensure our office has a warm and inviting feel and our staff is compassionate in the care they give.

For more information about our dental care or to schedule an appointment, please contact The Dental Place at (361) 643-2522. We look forward to hearing from you!

Patient Forms

All forms must be filled out before we can provide service

Patient Medical Form

This form must be filled out by all new patients. In order to expedite your visit, print and fill in this form,
and bring with you on your first visit.


Adult Form

This is a general information form that lets us know a little about you.


Child Form

This form allows to get to know your child before our first visit.


Privacy Notice

Please read and sign our Notice of Privacy Practices, acknowledging our privacy policy


Financial Policy

This form details how insurance plays a part in paying for dental service


Medical Release Forms

This form must be filled out if we are to share your or your child’s information with other medical facilities.
This form also allows us to treat your minors.


Preferred Information

This form gives us more information to cater dental services to fit your specific needs.


We work with these insurances:

• Aetna US Healthcare
• Ameritas Life Insurance Corp
• Assurant Employee Benefits
• Blue Cross/ Blue Shield
• Cigna
• Delta Dental
• Dental Network of America
• GEHA – Connection Dental
• Guardian
• Humana Dental
• MetLife
• Mutual of Omaha
• Principal Insurance
• United Concordia
• United Healthcare

Forms of Payment

All copays are due immediately upon service

All uninsured patients must pay for service in full at time of check out. We accept these forms of payments:

• Cash
• Check
• MasterCard
• Visa
• American Express
• Discover