Thomas E. Jacka D.D.S.

700 S. 320th St., Suite E, Federal Way WA. 98003

(253) 946-3575

Patient Forms

Patient Forms

Please take a minute to print and fill out the patient information form before your first appointment:

Adult Dental History [PDF]

Adult Medical History [PDF]

Adult Registration Form [PDF]

Child Medical Dental Form [PDF]

If you're unable to open PDF files, you can get Adobe Reader for free.

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