Patient Forms


Thank you for scheduling your first appointment with Fountain Valley Dental!

Please click on the link below to print and fill out our New Patient Welcome Packet. Completing these simple forms in advance and bringing them with you to your appointment could save you extra time and hassle when you arrive.

New Patient Welcome Packet

We look forward to seeing you!

-Fountain Valley Dental team

Hope for Kaisha

About 3 years ago Kaisha was diagnosed with a debilitating condition called Complex Regional Pain Syndrome (CRPS). She has been provided with an opportunity to receive treatment in Arkansas with a Doctor who is having great success treating people with her diagnosis. She is the only Doctor in the United States that is able to provide this treatment. We are raising financial support to help Kaisha be able to receive this unique treatment and hopefully regain some of what she has lost. Would you consider sharing her story with your friends/family. A You caring link has been set up to receive donations. Please feel free to reach out with any questions at hopeforkaisha@gmail.com

www.youcaring.com/kaishaohta

Coloring Contest

Ages 4-8 and 8-12
Now through December 20th
Winners will be chosen in both groups
on Dec 21st
Prizes include:
1st place: $25 gift card to Toys R Us
2nd and 3rd places: $10 gift cards to Pips.
Pick up your coloring sheet in our office
Or Click Here for a download
Contact Us




Our Location
FOUNTAIN VALLEY DENTAL
Dr. Benjamin Whitted
1400 Fountain Way
Molalla OR 97038
Call: 503.759.3333