Ferguson Family Dental

New Patient Forms

Welcome to Ferguson Family Dental! We look forward to getting to know you better so that we can set you on a path towards optimal oral health and a brighter smile.

Please arrive at your appointment 15 minutes early to fill out or update your Health History Information. We will ask you for information about the following:


Basic Contact and Personal Information

Most Recent Physical Exam

Current Care from a Physician (if applicable)

Past Hospitalizations

Current and Past Illnesses

Current and Past Medications

Allergies or Ill Effects from Medications

Women – Pregnant or Nursing


If you would prefer to print and fill out this information ahead of time, please find our form here.


Feel free to give us a call if you have any questions. See you soon!

Health History Form

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (509) 747-5184
View the ADA Accessibility Statement