1205 SE Professional Mall Blvd., Suite #202
Pullman, WA 99163
Phone: 509-332-8084          Fax: 509-332-6380

FORMS


PLEASE NOTE: Your privacy is very important to us, and we strictly adhere to all HIPAA regulations regarding your protected information. In order to set up your account with Pullman Dental Care and also to allow us to provide optimal care and assist you with processing your dental insurance, we request that you complete the PATIENT REGISTRATION FORM  and the MEDICAL/DENTAL HISTORY FORM prior to your first visit. You may bring these forms with you to your first visit, or you may mail them to:

Pullman Dental Care
John S. McInturff, DDS
1205 SE professional Mall Blvd.
Suite #202
Pullman, WA 99163

If we receive your forms prior to your first visit, we will be better able to provide you with accurate insurance benefit estimates at the time of your visit.

To view a printable version of our PATIENT REGISTRATION FORM CLICK HERE.

To view a printable version of our MEDICAL/DENTAL HISTORY FORM CLICK HERE.