Harbor Kids' Teeth
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Patient Forms

All new patient forms are available online for you to complete, print, and bring with you to your child's dentist appointment with Harbor Kids.

Just fill in your information directly on each form and print out once you have completed the form, one by one.

For DSHS patients only

For hospital and general anesthesia patients only

These documents require Adobe Reader for complete accessibilty and functionality.
Click here to download for free if you do not have this software.

Download PDF

If you have any issues accessing these forms, please call our office at 253-858-8581 for more information or paper copies.

For office use only:

We are here to serve you, answer questions or schedule an appointment during the following hours:

Monday 8 a.m. - 5 p.m.
Tuesday 8 a.m. - 5 p.m.
Wednesday 8 a.m. - 5 p.m.
Thursday 9 a.m. - 5 p.m.
Friday 9 a.m. - 2 p.m.

Call us at (253) 858-8581 to schedule an appointment for your child. Please contact our office 24 hours in advance if you need to reschedule or cancel an appointment.

Patient Forms
FAQ - About Teeth
Office - Take a Tour
Lisa A. Block, DMD, MS

Doctor block is the best Dentist ever

- Charlotte, Age 7

  • Washington University, Doctor of Dental Medicine
  • University of Missouri, Masters in Oral Biology
  • Board certified by American Board of Pediatric Dentistry
  • Diplomate, American Board of Pediatric Dentistry
  • Fellow, American Academy of Pediatric Dentistry
  • Member of the American Dental Association and the Washington State Dental Association
  • Former Board Member of the Washington State Oral Health Foundation
  • Board member of Mary Bridge Children's Hospital Foundation
  • Past President of Washington State Academy of Pediatric Dentistry
  • Champion of Pierce County ABCD (Access to Baby and Child Dentistry) program

3519 56th Street NW, Suite 140,
Gig Harbor, Washington 98335
Phone: (253) 858-8581
Fax: (253) 858-2189