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Patient Forms

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Family happy to know that they can fill out their Richland, WA dentist forms conveniently online

Help us get to know you!

As your Richland dentist, Drs. Bunch and Kleist understand that your time is valuable. In order to streamline your visit, you can access all of our Midtown Dental Clinic patient forms online, complete them at your convenience prior to your appointment, and bring them in with you to the office.

If you would rather complete paperwork at our office, we ask that you arrive 15 minutes before your scheduled appointment, enjoy a complimentary beverage, and feel free to ask for our assistance with any questions you might have.

To download and fill out forms ahead of time:

    1. Click on the links below to open each form in a new tab.
    1. Click the “Download” button, or right-click and select “Save Page As” to save the form to your computer.
  1. Once downloaded, open up each PDF document in Adobe Reader. To complete the forms, click in each blue box and type your answer; then save the document when you are done and print it out. (You can also print the forms out first and write your answers.)
Please take a moment and fill out our patient forms below. If you have any questions along the way, feel free to contact our practice.

Patient Information Form

Medical History

Financial and Office Policy

HIPAA Notice of Privacy Practices

Acknowledgement of Privacy Practices

Authorization to Release Healthcare

If you’re unable to open PDF files, you can get Adobe Reader® at no charge.
We look forward to meeting you at your first appointment. Call our Richland office today at (509) 392-8022 for any questions or to set up your appointment!