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Ariel J. Raigrodski, DMD, MS, FACP
Norman P. Goodwin, DDS
Heidi R. Johnson, DDS
Request Appointment
Lynnwood, Washington
Lynnwood, WA

Referral Form

Required fields are marked with asterisks (*).

Patient Information

Patient Name: *

Street Address: *

City: *

State: *

 

Zip Code: *

 

Phone: (home) *

Work:

Cell:

 

Referred By: *

Office Email: *

Nature of Examination

Comprehensive

Implants

Removable Prosthodontics

 

Occlusion

Aesthetics

Fixed Prosthodontics

 

Treatment Suggested:

X-rays you will be sending:

FMX

BWX

PAN

PAX

CT SCAN

 

Comments:

Length of time in your practice:

Treatment rendered:

Confirmation

How do you prefer to be contacted? *

  Email   Phone  

Like you, we are committed to excellence in patient care.
Unless otherwise directed, we will be happy to contact and make arrangements for your patient's appointment.

 
 

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We are your dental home for comprehensive care in a nurturing environment.
Call or click to make an appointment.

Request your appointment
Building relationships through trust and quality care.




Ariel Raigrodski, DMD, MS, FACP
Norman Goodwin, DDS
Heidi Johnson, DDS

On-call evenings and weekends.





19020 33rd Ave W Suite 200
Lynnwood, WA 98036
Call (425) 697-9665


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