Request an Appointment

Please fill out the form below and we will contact you with an appointment time. Required fields are marked with asterisks (*).

Patient Information

Name: *

Phone: *

Email address: *

Have you visited our office before?: *

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What is the reason for the appointment?: *

Regular exam / cleaning
Specific concern / procedure

What concerns, if any, would you like to speak to the doctor about:

 

Confirmation

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LOCATION

Jeff Johnson, DDS
5611 119th Ave SE #5
Bellevue, WA 98006

Call (425) 644-0300
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