New Patient Forms
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 Appliance Adjustment Follow-Up
TMD Links:
TMD Head, Neck Pain Exam and Workup
Other Links:
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