New Patient Forms

Please click the buttons to download the forms.

New patients can save time by printing and filling out the forms below prior to their first appointment. Please bring the completed forms with you to the office.

Patient Registration Form
Office Policy
Confluence Dental Membership Form page 1
Confluence Dental Membership Form page 2
patient registration Form in Spanish
Office Policy form in Spanish
Medical History Form
Madical Histroy form in Spanish
HIPPA form
HIPPA form in Spanish
Credit card Authorization Form
COVID-19 screening form in Spanish
COVID-19 Patient Screening form
COVID-19 Dental treatment consent form
Authorization of releasing record form

Accepting New Patients!

For more information or to schedule an appointment, call our office at 509-886-0500.

Accessibility by WAH
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