New Patient Registration Form

New Patient Medical History

Notice of Privacy Practices Form

Welcome to our office!  We practice what we preach!  We are different because when you choose dental care with us you have access to a network of comprehensive and specialty dental care practitioners who communicate together regularly for comprehensive, convenient, accessible dental health care supported by the latest technology and research, commitment to patient education and dental disease prevention, and personal dental care planning with comprehensive follow-up.   

Sleep Links:

Sleep History/Exam/Workup

Sleep Appliance Adjustment Follow-Up

Sleep Long Term Follow-Up

Sleep Screening Consultation

TMD Links:

TMD Screening Consultation

TMD Head, Neck Pain Exam and Workup

Other Links:

Oral Surgery/Implant

Periodontal Questionnaire and Exam

Orthodontic Questionnaire and Exam

 

[PATIENT RIGHTS & RESPONSIBILITIES / HIPPA] (link under construction)

 

To Help Someone You Love Receive Dental Care:

Dr. Emerson offers Gift Cards! 

Available in any amount.  For an initial examination with diagnostic radiographs we recommend $150 – $300.

 

GIFT INFORMATION:

Gift Amount _____________________________

To _______________________________________

From ____________________________________

Gift Message ___________________________

 

DELIVERY METHOD:

       ► Pick up at North Seattle Restorative Dentistry

       ► Mail to Billing Address

       ► Mail to Recipient Address

 

PAYMENT METHOD:

Please contact our office for payment – 425-486-2715