Thomas E. Jacka
700 S. 320th St., Suite E
Federal Way, WA. 98003

253.946.3575 / PHONE
253.946.1085 / FAX

drjacka@federalwaydentaloffice.com / EMAIL

FORMS: Please feel free to download, print and bring these completed forms to your initial visit appointment.


  • Patient Registration (Child)

  • Patient Registration (Adult)

  • Health History

  • Dental History

  • HIPPA Form

    • Contact Information

    700 S 320th St, Suite E
    Federal Way, WA 98003

    phone: 253-946-3575
    fax: 253-946-1085

    Email Us

    Directions