
Photo ID (such as a valid driver’s
license)
Insurance card (for those who would
like to use dental insurance)
Any questions, concerns, hopes, and
goals

Photo ID (such as a valid driver’s
license)
Insurance card (for those who would
like to use dental insurance)
Any questions, concerns, hopes, and
goals

NEW PATIENT FORM
NEW PATIENT FORM



As a PPO provider for Washington Dental
Service (WDS) insurance, we have proudly
served Boeing employees and their families
for more than 20 years.
As a PPO provider for Washington Dental
Service (WDS) insurance, we have proudly
served Boeing employees and their families
for more than 20 years.
“I have been going to Benca dentistry for many years.
Over 15 years. They have such a great team. All are so kind and helpful. I hate going to the dentist, but they make it so much better. I Highly recommend Benca
Dentistry.”
“I have been going to Benca
dentistry for many years.
Over 15 years. They have
such a great team. All are
so kind and helpful. I hate
going to the dentist, but
they make it so much better.
I Highly recommend Benca
Dentistry.”

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