Thank you for entrusting us with your periodontal and dental implant needs.

dental implant

Step 1: Fully Secure Web Documents

secure web documents

Our system will allow you to input and submit your information both securely and privately, usually in less than 10 minutes.  Upon submission the system will send a copy to you and us for your file in our office.*

By receiving this paperwork in advance of your first visit we can:

  1. Check your insurance benefits before your appointment
  2. Review your health and dental history and better prepare for your first consultation
  3. Obtain additional appropriate documentation, photos and most importantly x-rays from your care providers before your appointment so that exposure to radiation and costs can be reduced
seattle periodontist

Step 2: The Forms Included in this Packet

dental implant
  1. Financial Arrangements Policy
  2. Acknowledgment of Privacy Rights/Form 3-B*
  3. Appointment Re-Scheduling, Cancellation and No-Show Policy
  4. Your Health History
  5. Your Health Care Provider Contact Information

* To review or download a copy of our HIPAA privacy policy, please CLICK HERE.

gum graft

Step 3: Tips for Filling out the Forms

Filling out the forms couldn't be easier especially if you follow these simple tips:

  1. Use your mouse to scroll up and down the forms or use the green arrow in the left margin to guide you
  2. Once you fill in a field the form will auto fill that same information for you if it's needed elsewhere in the paperwork (e.g.: your name)
  3. At the bottom of the forms there is a counter to tell you how many fields are left to fill out, etc.
  4. Once you have completed everything, click the green button at the bottom labeled "Click to eSign"
  5. If you would prefer to download the forms to fill out by hand, you can get them here New Patient Paperwork

*Your personal information (i.e. name, birth date, email address) is protected in your secure and personal folder and will not be shared with any company or person.

Please email our office all photos and radiographs prior to your visit.

Have a Question?

Contact Pacific Northwest Specialists in Periodontics and Dental Implants

Follow Pacific Northwest Periodontics