Goichi Shiotsu, DDS, PS

Prosthetic & Implant Dentistry

Creating Beauty and Success By Design

New Patient Forms

Patient reviewing paperwork on his laptop

Click each link below to download the PDF file. Please print out these forms and complete them before your visit to save time at your schedule appointment!

Patient Registration
Health History
HIPPA Acknowledgement
HIPAA Statement of Privacy Practices (for patient to keep)

If you have questions about the services we provide, please call us at (206) 232-3600.

Goichi Shiotsu, DDS

Mercer Island, WA

Location
2825 80th Ave SE Suite 3
Mercer Island, WA 98040-2985

Hours
Tuesday-Friday: 8am - 5pm

Maps & Directions

After Hours Info

Contact Us

New Patient Forms | Mercer Island Dentist | Goichi Shiotsu, DDS
Please print out our new patient forms and complete them before your visit to save time at your schedule appointment!
Goichi Shiotsu, DDS, 2825 80th Ave SE, Suite 3, Mercer Island WA 98040 ~ (206) 232-3600 ~ mercerislanddental.com ~ 12/30/2021 ~ Page Phrases: dentist Mercer Island WA ~ dentist Mercer Island WA ~