We have provided this secure online registration for your convenience.
Please be aware that once you have started the forms online, that extended delays in filling out the forms can cause the security system to time out and you may have to start over. So gather your Physicians's name, address and contact info as well as your list of any medications in advance to make it easier for you.
Please fill out the entire form and be sure to click SUBMIT at the very end so that it will record your entries and we can be prepared for you when you arrive for your appointment. Click on the button below to begin:
Trent Young, DDS
Dr. Trent Young
phone: (503) 363-0292
fax: (503) 363-2966
1257 Wallace Rd. NW
Salem, OR 97304-3007