Mark E Jensen - General Dentistry - Bend, Oregon
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New Patient Forms


Please print, fill out & bring into our office
when you come
.

Health History

Hippa and Privacy Policy

Hippa Acknowledgement

Non-Discrimination Notice


Financial Policy:
For your convenience, we accept Visa & MasterCard. We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us.  Many times, a simple telephone call will clear any misunderstandings.

Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.

We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated. We can make arrangements for a monthly payment plan through Citi Health Card but that must be implemented prior to the actual procedure.

199 SW Shevlin Hixon Drive, Suite A, Bend, Oregon 97702
Phone: (541) 330-5952 • Fax: (541) 330-5935
jensendmd@bendbroadband.com



Our Office Philosophy


To provide or facilitate the finest dental care possible in an empathetic and comfortable setting; to do so in a positive and fun aire whenever possible. Our measure will always be: "What is the best thing for the patient?"