Schedule Office Appointment

Please use our Zocdoc online scheudler yellow button or you can fill out our New Patient Forms and then send us your appointment request information below, we will be in contact with you shortly after your form submission. Our dental office serves clients in the Bellevue, Seattle, Redmond, Krikland, Sammamish and Issaquah areas.

Fill out our form as completly as possible for us to best assist you!
*Denotes A Required Field

*Full Name:


*Email Address:


*Phone Number:


Preferred Appointment Time:


Preferred Appointment Date:


Insurance Company Name:


Insurance Company ID#:


Insurance Company Group#:


How did you hear about us?:
Select One Google Search Yahoo Search Bing Search Word of Mouth Referral Other Search



In the box below, please type the
characters shown in the picture above - (CASE SENSITIVE)


Additional Comments and Reason for Visit:

New Patients Welcome