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Forms
Forms that should be filled out by all patients.
Patient Registration
Medical History
Appointment Policy Statement of Patient Responsibility
Patient Records Release and Duplication Policy
Insurance Policy Forms
Managed Care Dental Coverage and Financial Policies
PPO and Indemnity Dental Coverage and Financial Policies
Forms to be used as applicable.
Minor Consent Form
Patient Records and Duplication Policy
Authorization to Release Health Care Information
If you have any questions about the forms you should
complete, please call our office at (206) 343-8929.
Notice of Privacy Practices