New Patient Forms

Please download all the forms for your visit and bring them with you to your New Patient or Returning Patient visit. If your dental insurance has recently changed, or if your contact information needs updated, please call our office prior to your scheduled appointment so we can update our system and your benefit information accordingly.

Click on a link below to download the PDF form:

•	New Patient Form
•	Acknowledgment of Privacy
•	Notice of Privacy Policy
•	Patient Agreement Form & Financial Policy
•	Dental History Form
•	Medical History Form

Time to schedule an appointment?

At Bella Dental Care, we create a strong emotional investment in each and every patient we serve, and we want to show you how amazing your dental experience can be! Are you ready to schedule your appointment with us? Call us at (425) 208-0032 or fill out or online appointment request form today!

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Our family welcomes your family

Marie Durflinger, DDS
Rima Abifaker, DDS

Call (425) 208-0032

Bella Dental Care
1550 140th Avenue NE Suite 110,
Bellevue, WA 98005-4500

Open Monday–Friday

Patient Forms

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New Patient Forms | Bella Dental Care | Bellevue, WA
Please download all the forms for your visit and bring them with you to your New Patient or Returning Patient visit.
Bella Dental Care, 1550 140th Ave NE, Suite 110 Bellevue, WA 98005 • (425) 208-0032 • bellasmiles.com • 11/21/2021 • Tags: dentist Bellevue WA • dentist Bellevue WA •

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