Patient Forms

Patient Form Instructions:
1. Please download both of the following forms to your computer.
2. Once saved, please open the documents and complete the fields
3. When done, re-save your documents and email them back along with your photo ID and insurance card to our office at least 72 hours before your appointment.

Kirkland email: info3@mkperio.com Tacoma email: info@mkperio.com

Patient Forms

Download

Consent for Treatment

Download

Medical History Form

Download

Statement of Privacy Practices

Download

Records Release

Download

Post-Operative Instructions

General Pre-Op Instructions

Download

Oral Sedation Pre-Operative Instruction

Download

Post-Op Instructions

Download

After Sedation Instructions for the Companion and Patient

Download

For any questions about any of our forms or for more information, contact our office in the Tacoma area at (253) 752-6336.