Patient Forms

If you are a new patient to our office, please complete the forms listed below. Many patients find that completing them online is quicker and easier than filling them out at the office. Just click, complete, and print! Please call our office if you have any questions at all. Thank you!

Patient Forms (Print & Complete All Forms Prior To First Office Visit)

Confidential Patient Info

Medical History

Dental History

Statement of Privacy Practices

Acknowledgement of Receipt of Notice of Privacy Practices

Financial Agreement


Schedule Your Appointment!

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5615 Valley Ave. E., Tacoma, WA 98424


(253) 922-6822


Monday - Thursday
7am - 4pm

©2019 Distinctive Dentistry, Keith Phillips DMD, MSD