Alem Family Dental

Generations of Smiles

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Forms

The following forms are provided for your convenience and to help expedite the paperwork process. The forms can be printed, filled out, and brought in or faxed to the office at 206-417-6455.

Patient registration

• Personal Information and Health History (100KB PDF)
• For children age 16 and under, please fill out both forms below:
  1. Children's health history (96KB PDF)
  2. Patient information (52KB PDF)

We look forward to welcoming you.
For an appointment call 206-4-1-SMILE (206-417-6453).

Alem Family Dental accepts most insurance.