Our Location

1001 Broadway
Suite 218
Seattle, WA 98122
Ph. (206) 329-0410

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Forms

If you are a new patient to our practice, you can save time at your first appointment by filling out the following forms online.

If you have questions about any of the forms please feel free to call us at (206) 329-0410.

Patient Health History Info
Patient Insurance Info
Financial Policy
Acknowledgement of Privacy

The forms below PDF documents. You will need Adobe Reader to view them.

Download Forms

Statement of Privacy Practices 102611.pdf

Patient Satisfaction Survey

We know it can be a long road to excellent oral health and we congratulate you on completing your treatment with us!  By following the treatment plan that your general dentist and our doctor has outlined, you have a solid foundation to build on that will aid in your overall health.

We know that you have several options in the area for your periodontal needs and we want to thank you for choosing First Hill Dental Implant Center.  Although your treatment has come to a close, we hope we have established a relationship with you where you felt that you were treated with respect, were informed adequately throughout treatment about what would be taking place, and felt like we treated you as a life-long member of our practice.

Below is the link to our Patient Satisfaction survey.  We hope you can take a few minutes to let us know how you viewed your experience with us.  We have found it extremely helpful for us to gather this information so we can ensure that we are giving all of our patients the best care possible – we believe our patients deserve it.  We know your time is valuable and we greatly appreciate you taking the time to complete the survey.

If we can ever be of service to you, a family member or a friend in the future, please do not hesitate to give us a call.

Patient Satisfaction Survey