605 E. Holland Ave., Suite 108 • Spokane, WA 99218 • Phone: 509-465-5001
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Patient Medical/Dental Health History
New patients or existing patients updating medical history
Request Records from Previous Dental Office
Transfer existing x-rays and records
Please print forms and fill out at your convenience, and bring them to your first appointment. If you have old dental x-rays or records that need to be transferred please submit 1 week prior to your dental appointment.