Pine Lake Dental Care

Experience The Difference

  • (425) 392-2103
  • 22727 SE 29th Street
    Sammamish, WA 98075
patient forms

Patient Forms

 

Help us get to know you!

 

Please take a moment to download, print and fill out our patient information forms. Please bring the completed forms with you to your initial appointment. If you have any questions along the way, feel free to contact our practice.

We are as concerned with your overall health as we are with your oral health. Please bring a list of any medications that you are presently taking. Please alert the office if you require pre-medication prior to dental cleanings (i.e. antibiotic pre-med).

» Medical History Form PDF
» Dental History Form PDF
» Patient & Responsible Party Information Form PDF
» Notice of Privacy Practices PDF
» Acknowledgement of Privacy Practices PDF
» Financial Policy PDF

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We look forward to meeting you at your first appointment.

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