Patient Forms

filling out forms

On-Line Registration forms Click Here
This completely secure, encrypted and confidential form is sent directly to our office. You can use the Tab button to quickly move to the next field.  Make sure to sign each document and click on Submit once when you’re finished.

PLEASE NOTE: We are accepting new patients, however our first availability is usually 1-2 months out unless you have an emergency. Please call us if you have an urgent need.


 

Print PDF New Patient Registration Click Here
If you prefer, you may download, fill out and fax this form to  (425) 837-0636 or bring it with you to your first appointment. If you do not have Adobe Acrobat, click here.

 

Fill out as much information as you feel comfortable with and we will contact you as soon as we receive your submission.

 

If you have any questions please call us at (425) 837-0634 or send us an e-mail.


 

Existing Patients
Submit Acknowledgement of Privacy Practices
New regulations require us to inform all patients of record of their rights regarding their dental records. Please read this section and submit your acknowledgment.