Dentist Yakima WA | Emergency & Family Dentist | Yakima Healthy Smiles

New Patient Forms

Save time at your first visit! Complete our new patient form before your appointment and we'll have everything ready when you arrive at Yakima Healthy Smiles.

📋 How to Complete Your Forms

  1. Download the form using the button below
  2. Print and fill it out at home, OR fill it digitally if you have a PDF editor
  3. Bring the completed form to your first appointment
  4. OR arrive 15 minutes early to complete forms in our office

Download New Patient Form

Click below to download and save the form to your computer

Download PDF Form

Preview the Form

Can't see the form? Click here to view in a new window

What to Bring to Your First Appointment

  • Completed New Patient Form (or arrive 15 minutes early to fill it out)
  • Photo ID (driver's license or state ID)
  • Dental Insurance Card (if you have insurance)
  • List of Current Medications (including dosages)
  • Previous Dental X-Rays (if available - or we can request them)
  • Any Questions or Concerns you'd like to discuss with Dr. Kezele

Need Help with the Form?

Our friendly team is here to assist you! Give us a call and we'll answer any questions.

(509) 965-3235

Ready to Schedule Your First Visit?

Contact us today to schedule your appointment with Dr. Kezele at Yakima Healthy Smiles!

Schedule Appointment →