16650 NE 79th Street, Suite 100, Redmond WA, 98052
(425) 558-4562

ADA Accessibility Information
Accessibility
A
A
A

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? *

Yes No  

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:

 

Our office will contact you by phone within the week to schedule an appointment. If you need prompt assistance please call us directly at (425) 558-4562.

 
 

It may take a moment to submit your information. Please wait for a confirmation message.

 
Get in TouchWith Us!
16650 NE 79th Street
Suite 100
Redmond, WA 98052
P:(425) 558-4562
F: (425) 558-4572
Redmond Kids Dentistry | | (425) 558-4562
16650 NE 79th Street Suite 100,Redmond, WA 98052
Copyright © 2011-2017 Redmond Kids Dentistry and WEO MEDIA. All rights reserved.  Sitemap | Links