Home
 Book Now  Make A Payment
Mount Vernon: (360) 424-7089
Tap for Menu
  • Home
  • About Us
    • Meet Dr. Lupita Fernandez
    • Meet Dr. Holden
    • Meet the Team
  • New Patients
    • Office Visits
    • Financial Information
    • Patient Forms
    • Office Tour
    • Testimonials
    • Español
  • General Dentistry
    • Common Procedures
    • Preventive Care
    • Gum Disease
    • Cosmetic Dentistry
    • Periodontal Treatments
    • TMJ-TMD
    • Emergency Dental Care
    • Dental FAQs
  • Modern Dentistry
    • Digital X-rays
    • Intraoral Camera
    • Oral Cancer Screening
    • Philips Zoom!
    • Implants
    • Nitrous Oxide
  • Pediatrics
    • Pediatric Dentistry
    • Dental Care for Your Baby
    • Pediatric Dental Emergencies
    • Pediatric Dental FAQs
    • Sports Dentistry
    • Thumb Sucking
  • Contact Us
    • Office Location
    • Appointment Request
    • Post-Appointment Survey
    • Refer a Friend
    • Refer a Patient

Office Visits | Financial Information | Patient Forms | Office Tour | Testimonials | Español

patient forms

Patient Forms

You can fill these out at home and then bring them with you to your appointment to save time.

  • Insurance and Financial Policy Form
  • Privacy Practices Information Form
  • Patient Information Release Form
  • Patient Registration Form
  • Patient Medical and Dental History Forms
  • For our existing patients and new patients please click here to complete your forms online (preferred method)

If you're unable to open PDF files, you can get Adobe Reader® for free.

Say Hello.

Mt. Vernon Office 1711 East Division Street
Mount Vernon, WA 98274
(360) 424-7089

Send Us a Message

American Dental AssociationWsdaPhilips Zoom
Website Powered by Sesame 24-7™ | Site Map