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425-271-1727

17900 Talbot Rd S Suite 103, Renton, WA 98055

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This page contains information about our Patient Information and Medical History forms. If you have any questions about these forms, please contact Valley Dental Group in Renton, Washington, at 425-271-1727. After you have reviewed our information, you can print copies to fill out and bring with you on your first visit, or you can mail it ahead of time. Please take time to view the personal, medical and dental history information that you will be asked to provide. Please call us at 425-271-1727 if you have any questions.

Please read and know that you will be asked to provide this information before any services will be rendered.

Filling this information out ahead of time makes your visit with one of our dentists, Dr. Robert Brian Kane, Dr. Doris Chan and Dr. Luke St. Marie, more efficient and allows our team to focus on you and your dental needs.

Click on a link below:

***If you are having difficulty accessing or understanding any form pertaining to Valley Group Dental, please contact our office. We will be happy to assist with your specific needs.

PDF Forms – Need Acrobat Reader? It’s free!
Adobe PDF

HIPAA Acknowledgement of Receipt
Patient Information Medical History
Valley Dental Group Financial Policy
Dental Charges Agreement
VDG HIPAA Extended Version
Authorization for Use