Call for an Appointment Today: (206) 362-5911
11066 5th Ave NE, Seattle, WA, 98125
  










Considering a dental restoration? There are many different restoration materials to choose. For a comparison of the pros and cons check out the ADA's comparison chart here.
Patient Questionnaire
To save time at your initial appointment, please click on the appropriate links for you or your child, print it, fill it out and bring it with you to your first appointment.

1. If the patient is a child (under 18) please download and print these two forms.
Child Patient Information, Child Medical History

2. If the patient is an adult (over 18) please download and print these two forms.
Adult Patient History, Adult Medical History





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Amrit Burn Orthodontics | www.drburnorthodontics.com | 206-362-5911
11066 5th Ave NE, Suite 207, Seattle, WA 98125
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