16650 NE 79th Street, Suite 100, Redmond WA, 98052
(425) 558-4562
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Patient Forms
Welcome to our practice! We are excited that you have chosen us for your child’s dental home. It is our privilege to be able to make kids (and parents) smile!

In order to make your first visit as smooth as possible, we ask that you read and complete our new patient forms. If you have dental insurance, we will do our best to verify eligibility for your child. Therefore, please submit your forms at least 1 business day before your appointment. Please click the links below to complete our forms.



If your child is an existing patient of our practice and you will be unable to attend your child's appointment with them, please complete the Existing Patient Update Forms prior to their appointment. Please be sure to list any individual who may accompany your child in the “other category” under the Additional Disclosure Authority.



If your child is transferring to a new dentist, or you need to share their dental records with an additional provider, please complete the Records Release Form.




Policies


A word on insurance: We are a preferred provider (in-network) for Premera and Regence. Even if you have a different dental insurance, we will still submit your claim for you as a courtesy. Please refer to our Financial Policy form for more information, and we
Get in TouchWith Us!
16650 NE 79th Street
Suite 100
Redmond, WA 98052
P:(425) 558-4562
F: (425) 558-4572
Redmond Kids Dentistry | | (425) 558-4562
16650 NE 79th Street Suite 100,Redmond, WA 98052
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