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Kenmore 425.486.9111

Online Forms and Registration

For Patients
For your convenience, we've made it possible to fill out your registration form online through our secure server. After you have completed the form, make sure to press the Submit at the bottom to automatically send us your information. When you come in for your first visit, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Patient Registration Form

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Contact Us
Implant and Periodontal Associates Northwest

Uplake Professional Center
5723 NE Bothell Way, Suite C & D
Kenmore, WA 98028

Phone: 425.486.9111
Fax: 425.489.1923


Kenmore Office
Richland Office