New Patient Forms

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!

•	Health History
•	Patient Registration
•	HIPPA Form
•	Statement of Privacy Practices

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

Goichi Shiotsu, DDS

Mercer Island, Washington

Location
2825 80th Ave SE, Suite 3
Mercer Island, WA 98040-2985
Hours: Tuesday - Friday 8:00am - 5:00pm
(206) 232-3600

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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 \ 3/16/2021 \ Tags: dentist Mercer Island WA \ dentist Mercer Island WA \

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