Clearwater Dental
Dr. Jerry Han, Dr. Eric Rose, Dr. Lance Rhoten
Clearwater Dental
Dr. Jerry Han, Dr. Eric Rose, Dr. Lance Rhoten
Contact Us
Leave a Google Review
(509) 783-5000
Clearwater Dental
(509) 587-1648
Pay Online
Home
About
Our Team
Dr. Jerry Han
Dr. Eric Rose
Dr. Lance Rhoten
Dr. Alexa Ellingsen
Technology
Services
View All
Family Dentistry
Children's Dentistry
Dental Implants
Cosmetic Dentistry
Dental Cleanings and Exams
TMJ/Bruxism Treatment
Snoring & Sleep Apnea Treatment
Composite Fillings & Bonding
Dentures and Partials
Crowns and Bridges
Testimonials
Patient Info
View Patient Info
Forms
Retirees
Financial
FAQs
Contact
Clearwater Dental
>
New Patient Forms
New Patient Forms
Save time by filling out forms ahead of time. Feel free to call us with any questions!
New Patient Packet
Fill Out Online
Records Release Authorization
Fill Out Online
New Patient Questionnaire
Fill Out Online
Medical History
Fill Out Online
Acknowledgement of Notice of Privacy Practices
Fill Out Online
Financial Policy
Fill Out Online
Quick Links
Patient Info
Financial Info
Frequently Asked Questions (FAQs)
Hours, Location and Contact Information
Are You Ready to Book Your Next Dental Visit?
Contact Us
If you have difficulty using our website, please
email us
or call us at
(509) 783-5000
View the
ADA Accessibility Statement
Turn on ADA Views
OK!
×
×
Contact Us Today
Give Us A Call
Clearwater Dental -
(509) 783-5000
Send Us an Email
Request an Appointment
Contact Us
Ready to Schedule an Appointment?
Book Online
Have Questions? Contact Us:
Required Field
Your Name:
Phone (call ):
Email:
Are you a new patient?:
Are you a?
New Patient
Current Patient
How would you like us to contact you?
Please choose
Email
Call
How did you hear about us?
Please choose
I'm an existing patient
Google/Bing
Mailer
Word of mouth
Social media
Other
Who Referred You?:
Appointment Preferences
Monday
Tuesday
Wednesday
Thursday
Friday
Your Message:
This site is protected by reCAPTCHA and the Google
Privacy Policy
and
Terms of Service
apply.
Sending...
×
This Patient's Experience
Loading Testimonial...
Loading Case...