New Patient Forms
To save time from filling out paperwork in the office, you may print out each of the PDF forms on your own to fill out, and bring into the office. Note they will open in a new window.
Tell us a little about yourself so we can best serve you and your unique needs.
Dental Record Release Forms
If you would like to authorize us to release your dental records to another practice, or would like us to receive your dental records from another practice, you may print out the PDF forms to fill out. You may bring them into the office or mail them to our address at: Clearwater Dental, 5000 W Clearwater Ave, Kennewick, WA 99336.
Part 1: New Patient Questionnaire
Part 2: Medical History
Although dental personnel primary treat the area in and around your mouth, your mouth is a part of your entire body. Health problems that you may have, or medications that you may be taking can affect your treatment.
Part 3 : Privacy Agreement
We keep a record of the health care services we provide you. By my signature below, I acknowledge receipt of the Notice of Privacy Practices for Clearwater Dental. We will not disclose your record to others, unless you direct us to do so or unless the law authorizes or compels us to. Our Privacy Practices describes in more detail how your health information may be used and disclosed, and how you can access your information. You may ask to see and copy that record at any time.