Federal Way Dentist - Patient Forms

Federal Way Dentists, Dr. Mike Farley and Dr. David Mace provide gentle family general, cosmetic and restorative dental care in a friendly and comfortable environment in Federal Way.

1825 South 324th Place, Federal Way, WA 98003

(253) 838-2018
(253) 927-1056

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Patient Forms

For your convenience, we have supplied a New Patient Registration form in pdf format. If you wish, click on the link below, print, complete the form at home, and bring it with you to your first visit! We look forward to greeting you!

· New Patient Registration Form - Adults

· New Patient Registration Form - Children

Adobe Acrobat Free Reader

New Patient Offer

Receive FREE Teeth Whitening
(In-home) Custom Trays with
New Patient Exam/Cleaning and Necessary X-rays.
(value of $325.00)
* Cannot be combined with other offers below

Refer-a-Friend
In appreciation of your referral, you will receive a $50.00 credit on your account and your friend will receive a $50.00 credit on their account!

Simply complete the form below by the deadline to take advantage of either of our special offers.

Offer Expires: 02/24/2012

<div style="text-align: center;"> 
New Patient Offer 
 
Receive FREE Teeth Whitening 
(In-home) Custom Trays with 
New Patient Exam/Cleaning and Necessary X-rays. 
(value of $325.00) 
* Cannot be combined with other offers below 
  
 
Refer-a-Friend 
In appreciation of your referral, you will receive a $50.00 credit on your account and your friend will receive a $50.00 credit on their account!    
 
Simply complete the form below by the deadline to take advantage of either of our special offers. 
</div>
<h3 style="color: red; text-align: center;"> 
 
Offer Expires: 02/24/2012</h3>

Please enter code above in the field below.

Federal Way Dentist Dr. Farley welcomes dental patients of all ages

Federal Way Dentist Dr. Farley welcomes you

Offer Expires: 02/24/2012

Federal Way Dentist · Precision Dental Care · 1825 South 324th Place · Federal Way, WA · Federal 98003