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Your First Appointment Starts Here — Just One Click Away.

Once your first visit is scheduled with our friendly front desk team, we invite you to complete your new patient forms through our secure online portal using the link below. The process takes approximately 10 minutes and allows us to gather important details, including your contact and insurance information, as well as a brief review of your medical history.

Completing these forms in advance helps our team at Seattle Periodontics & Implant Dentistry prepare for your visit and ensures a smooth, efficient appointment experience.

Finance

For your first visit, please bring your dental insurance card or policy details, including the policyholder’s name and group number, so we can process your benefits efficiently. We also offer flexible financing through CareCredit to help make treatment more affordable.

Financial Policy

For all treatment, we'll ask for payment of the portion of fees not covered by insurance at the time of your procedure. You can also pay your bill any time Pay Online, or over the phone. For more information,  Contact Us for questions or information regarding billing.

Cancellation Policy

We understand that sometimes appointments need to change. Please provide at least 48 hours’ notice so we can offer your time to another patient. Cancellations within 48 hours may incur a fee. Contact us as soon as possible if you need to reschedule.

How to Refer
a Patient

An initial examination is required for every new patient. This may be limited or comprehensive depending on the nature of the problem to be addressed. We have designed a special HIPAA Secure on-line referral form below for your use or you can download a copy of a printable referral form here. The form helps to gather relevant patient information. Referral pads are also available to assist the referring doctor in

communicating with our office.

Upon receiving the new patient referral information (via mail, email, phone or fax) our office staff will contact the patient and schedule the initial visit. When an appointment date has been set, a new patient package will be mailed or emailed to the patient. It contains directions to our office, parking instructions and a

number of forms including our medical form.

Referral Form

We have designed a special HIPAA Secure on-line referral form for your use or you can download a copy of a printable referral form using the above link. This form helps to gather relevant patient information.

Birthday
Month
Day
Year
Subscriber is:
Preferred Contact Method
Doctor Preference

Patient being referred for?

Periodontal Examination:
Implants
Perio-Ortho:
Gingival Grafts

Digital Radiographs & Pictures

  • FMX is requested for a Periodontal Evaluation

  • BWX or PA is requested for an Implant, Crown Lengthening or Graft Evaluation

Please Select Which Xray Format you emailed to us (FMX PREFERRED):

Please browse to and select the radiogrsphs, photos, or documents to upload.

Referring Doctor Information

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