Patient Forms

The link bellow will connect you to our Registration Form, Health History Form, HIPPA, and Office Policies & Proceedure Forms. Please complete and sign all forms. You will need to fill out a set of forms for each child. 
 

Upon completing ALL forms please click the "SUBMIT" button. Upon submitting your information please do not exit your screen until our website re-appears; indicating successful submition of information to our office. 

Please have your  Dental INSURANCE information, including the member/subscriber NUMBER available to enter into the Registration form.

 

CLICK HERE: Patient Forms  PDF                  

 

We look forward to meeting you and your child at your first appointment! If you have not already contacted us please do at 425-820-6633 or office@kirklandkids.com !