(360) 424-7089

Clarence E. Holden, DDS
1711 E. Division St.
Mount Vernon, WA 98274

New Patient Forms

photo of happy couple

Please prepare for your first appointment by completing our new patient information forms.  Please call our office and we will send you our New Patient Welcome Package.  Either send them in ahead of time or bring the forms with you to your first visit.  If you have dental insurance, we will need the ID number, Group number, address to send claims to, and SSN and birthday of the insured.

  • Printable Patient Information Form*
    Download this form to your computer to complete at home. Then bring it with you to your first appointment, in the event you are unable to obtain our New Patient Welcome Package (see above).
  • Privacy Policy*
    Please read our standard privacy policy document.

*This document is in Adobe PDF format. If you're unable to read PDF files, you can download Acrobat Reader free from Adobe.

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