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Patient Forms
For your new patient exam you will need to provide us with your health history and insurance information. Please complete the forms below and bring them with you to your first appointment. You may also email them using the following steps:

(Please note, you CANNOT directly save info typed into this form. If you would like to save the form please follow the steps below.)

1. Click New Patient Forms link to open below:

2. Fill in forms completely

3. Click print form button at the top right of the 1st page.

4. Select PDF Writer (May be called CutePDF writer) from your printer drop down list. (If you do not have a pdf writer you may install a free one by clicking here.)

5. Click Print/OK to save the Forms to your desktop using your child's name

6. Attach in an email to

- HIPAA Privacy Policy

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 are happy to answer any questions you may have.

Get the Free Acrobat Reader to view our forms.

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Redmond Kids Dentistry | | (425) 558-4562
16650 NE 79th Street, Suite 100, Redmond, WA 98052



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