Patient Forms

Home / New Patients / Patient Forms
We are dedicated to providing you with the best and affordable dental care. We always welcome new patients, and would like to thank you for referring family and friends to our practice.

Please use our online patient portal below to get started.

Patient Login   New Patient Form


Your initial appointment will consist of a consultation explaining your diagnosis and treatment options.

Occasionally, treatment can be done the same day as the consultation. However, a complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on another day.

Please assist us by providing the following information at the time of your consultation if possible:

  • Your referral slip and any X-rays if applicable.
  • A list of medications you are presently taking.
  • If you have medical or dental insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.
Please fill out our patient forms and bring it to your next visit to save you time in the office.






Let's Talk About Your Smile.

Our experienced team’s unique approach helps you take the first steps to optimal oral health.


Gold Line

Eastside Periodontics

Address: 13635 NE Bel-Red Rd, Bellevue, WA 98005
Phone: (425) 643-5412
Email: eastsideperio@gmail.com


Office Hours

Monday 8:00 AM - 2:00 PM
Tuesday 7:00 AM - 5:00 PM
Wednesday 7:00 AM - 5:00 PM
Thursday 7:00 AM - 5:00 PM


Write A Review







Gold Line