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Home Patient Info New Patient Forms

New Patient Forms


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New Patients


For new patients with an exam please fill out the appropriate forms below (Health History and HIPPA) prior to your exam appointment with us. Please fill out at your convenience (ideally a few days or more before your appointment) unlike the above forms which need to be filled out no sooner than 1-2 days ahead of your appointmen

If you have questions about any of the paperwork, please give us a call at 253-630-3331 and our staff will be happy to help you.



*We are committed to keeping your personal information secure. All of our online forms are submitted via a secure connection and are HIPAA compliant.
Dr. Jeffrey Kashner Orthodontics
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Dr. Jeffrey Kashner Orthodontics, 27015 169th Pl SE #201, Covington, WA 98042 • 253-630-3331 • nicesmilesonline.com • 4/9/2025 • Related Terms: orthodontist Covington WA •