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TUMWATER FAMILY DENTISTRY

(360) 999-5654

Your Premier Dentist in Tumwater, WA

Welcome to Tranquility Dental Wellness, where you will experience dentistry like you never have before! Our mission is to provide you with an amazing, relaxing, comfortable, five-star experience in a spa-like setting. We want dentistry to be low stress, so we offer flexible hours, flexible payment options and some pretty awesome complimentary comfort items. Come and see how we are doing dentistry differently!

Call us today to schedule your appointment with our dentists and learn more about dental care in Tumwater, Washington!

MEET OUR TEAM

MEET OUR DOCTORS

OUR AMENITIES

We want you to feel comfortable and indulged at our spa-like dental office! During your visit, we will provide you with our comfort menu featuring numerous amenities you can select. Some options are:

COMFORT MENU

Tranquility Dental Wellness offers a complimentary comfort menu to help you relax during your visit. We make your health and comfort our top priority, and you can expect us to take the time to ensure that you feel at ease when you visit our office.Our comfort menu includes:

Paraffin hand wax
Warm towels
Aromatherapy
Heated and massage chairs
Blankets
Pillows
Warm herbal neck roll
Netflix or Pandora with noise canceling headphones
Refreshment bar
Soothing eye gel mask

PAY ONLINE

Pay your bill online through our patient portal! Please click here to access the portal and make a payment!

FINANCIAL & DENTAL INSURANCE OPTIONS

We understand that each financial situation is unique and offer several options to work with your budget.

Tranquility Dental Wellness accepts most dental insurance providers. Please call us prior to scheduling an appointment to verify that we accept your insurance plan at our office.

We also offer in-house, interest-free financing — no credit check required!

We accept the following payment options:

Cash
Checks
Credit Cards
CareCredit

MAKE A PAYMENT

TEL: (360) 999-5654

704 TROSPER RD. SW, SUITE 102,

TUMWATER, WA 98512

HOURS:

MONDAY 7:00 A.M. – 6:00 P.M.

TUESDAY 7:00 A.M. – 6:00 P.M.

WEDNESDAY 7:00 A.M. – 4:00 P.M.

THURSDAY 7:00 A.M. – 6:00 P.M.

FRIDAY 7:00 A.M. – 4:00 P.M.

Request Appointment

0 + 1 = ? Please prove that you are human by solving the equation *

New Patient Questionnaire

Patient's Name *

First

Last

Patient's Nickname

Address *

Address Line 1

City

State

Zip Code

Gender *

Date of Birth *//

Race

Home Phone

Cell Phone *

How did you hear about us? *

Email *

Family members treated in our office

Reason for Consultation *

Previous Dentist

Date of last cleaning

Has the patient been examined by an orthodontist before?

Yes
No

Guardian #1 / Insurance Information

If "other" please specify below.

Guardian's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Preferred Phone

Employer *

Date of Birth *

SSN or Subscriber ID Number

Email *

Insurance Company Name (if applicable)

Subscriber/Member ID

Insurance/Customer Service Number

Sleep/Airway Issues

Does the patient tend to be a mouthbreather?

Yes
No

Does the patient snore at night?

Yes
No

Does the patient seem rested in the morning?

Yes
No

Is the patient often sleepy during the day?

Yes
No

Has the patient seen an Ear, Nose & Throat Specialist?

Yes
No

Is the patient using a sleep apnea device?

Yes
No

Dental/Medical History

Acid Reflux

Yes
No

ADHD/ADD

Yes
No

AIDS/HIV

Yes
No

Anemia

Yes
No

Asthma

Yes
No

Autism

Yes
No

Bone Disorders

Yes
No

Cancer

Yes
No

Cerebral Palsy

Yes
No

Chest Pain

Yes
No

Chronic Neck Pain

Yes
No

Clicking of Jaw

Yes
No

Jaw Pain

Yes
No

Cold Sores/Herpes

Yes
No

Diabetes

Yes
No

Down Syndrome

Yes
No

Endocrine Problems

Yes
No

Epilepsy

Yes
No

Headaches

Yes
No

Heart Condition

Yes
No

Hepatitis

Yes
No

Ear Pain

Yes
No

Immune Problems

Yes
No

Kidney Problems

Yes
No

Low Blood Pressure

Yes
No

Muscular Disorders

Yes
No

Nervous Disorders

Yes
No

Organ Transplant

Yes
No

Osteoporosis

Yes
No

Painful Chewing

Yes
No

Periodontal Problems

Yes
No

Prolonged Bleeding

Yes
No

Rheumatic Fever

Yes
No

Scoliosis

Yes
No

Seizures

Yes
No

Sinus Problems

Yes
No

TMJ Problems

Yes
No

Tuberculosis

Yes
No

Do your gums bleed when you brush?

Yes
No

Is the patient seeing any other dental specialists?

Yes
No

List specialists below (e.g.,periodontist)

Any dental restorations needing to be completed?

Yes
No

List dental restorations that need to be completed.

Have there ever been any injuries to the face, mouth or chin?

Yes
No

Explain below.

Have you ever lost or chipped any teeth?

Yes
No

Which tooth/teeth?

Do you have any pain or soreness around your face, neck or back?

Yes
No

Which tooth/teeth? (copy)

Is any part of your mouth sensitive to temperature or pressure?

Yes
No

Which tooth/teeth? (copy) (copy)

Is the patient currently pregnant?

Yes
No

Which tooth/teeth? (copy) (copy)

Have adenoids been removed?

Yes
No

Have tonsils been removed?

Yes
No

(copy)

Currently taking any medications?

Yes
No

(copy) (copy)

Are antibiotics necessary prior to treatment?

Yes
No

(copy) (copy) (copy)

Allergies?

Yes
No

Any diseases or problems not mentioned above?

Yes
No

(copy)

Please check if the patient has, or ever had, any of the following habits?

Cheek, tongue or lip biting

Yes
No

Clenching Teeth

Yes
No

Fingernail Biting

Yes
No

Grinding Teeth

Yes
No

Tongue Sucking

Yes
No

Thumb Sucking

Yes
No

Tongue Thrusting

Yes
No

SIGNED CONSENT

I understand the information given is correct and will be held in the strictest confidence. I also understand that it is my responsibility to inform this office of any changes in the patient's medical status. I hereby authorize this office to perform an oral evaluation and consent to the taking of x-rays, photographs and other records (if necessary) to determine appropriate orthodontic treatment on the above-named patient. I also authorize this office to leave messages about appointments on my voice mail or answering machine, and agree to receive e-mail reminders and text messages about appointments.

Typed Name/Signature *

Relationship to Patient *

Date *

If someone other than the parent(s) or guardian(s) listed above will be bringing the patient to appointments, please list here:

By submitting this form you agree to the above mentioned consent statement

LACEY, WA

(360) 339-4211

8050 FREEDOM LANE NE

STE C

LACEY, WA 98516

TACOMA, WA

(253) 444-2702

5005 MAIN ST

STE 107

TACOMA, WA 98407

TUMWATER, WA

(360) 999-5654

704 TROSPER RD SW

STE 102

TUMWATER, WA 98512

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