Distinctive Dentistry

From Patients

“I always feel comfortable in your office and I feel that the level of professional care is the best I’ve found anywhere.”
~Jeff Wick

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22315 Highway 99 N. Suite 1
Edmonds, WA 98026
(425) 771-3266
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Schedule An Appointment

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

Patient Name:*

Contact Name:

Relation to patient:

Home phone:*

Alternate phone:

Email address:*

Have you visited our office before?*

Yes No

If you are a new patient, how did you first hear about Distinctive Dentistry?

From A Friend Your Website Through a Search Engine (Google, Bing) Other

If Other

If you chose "Other" on the previous question, please tell us specifically. Maximum 150 characters.

Office Hours

Tuesday - Thursday; 7:00am - 5:30pm
Mondays & Fridays by appointment only

Scheduling Information

I would like to*

Schedule a new patient appointment Schedule a routine checkup Schedule a comprehensive dental exam Schedule a consultation Not sure (For example: I have a toothache and I need to see the doctor.)

Please enter up to three times that would work well for you (i.e. Thursday mornings" or "Wednesdays around 3pm").

First choice:

Second Choice:

Third Choice:

Confirmation

How do you prefer to be contacted?

Phone Email Either

If phone, when is the best time to contact you?

Additional Comments:

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"As Distinctive As You Are"

(425) 771-3266