Patient Forms


Existing Patients: 

1. COVID-19 + Info Update Form


New Patients:

1.   New Patient Forms PDF

2.   New Patient COVID-19 Form 

Please fill out each form for each child.
completing ALL forms please click the "SUBMIT" button ONCE. 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.

 


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 !

 


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