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David Richardson, DDS
Proudly Serving Our Community Since 1985


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New Patient Forms

From the first day you join our office, we will care for your dental needs.

As part of your first visit with us, you will fill out a comprehensive medical and dental history. This form is important because it helps us to determine the course of your treatment. We have to know about allergies, sensitivity to anesthetics, long-term medications, etc.

For your convenience we’ve included the New Patient Registration Form and the HIPPA Privacy Form below. Please click on the links to download and print out these forms at home, where you can fill out the New Patient Registration at your leisure and bring it with you to your first visit. Also, on your first visit, you’ll be asked to electronically sign the standard HIPPA form on a pad at our office.


Kirkland Dentistry | 11830 NE 128th Street, Suite 201, Kirkland, WA 98034
Phone: 425-823-6820 | Fax: 425-820-2427 | E-Mail: receptionist@kirklanddentistry.net
Business Hours: Monday: 8:30 a.m. - 5:00 p.m. | Tuesday - Thursday: 8:00 a.m. - 5:00 p.m.