Patient Form
Here at Everett Chicago Dental, we are dedicated to providing you with the best and affordable dental care. We always welcome new patients, and would like to thank you for referring family and friends to our practice.
Please print, fill out, and sign these forms for your new patient appointment. They may also be filled out when you come in if you prefer.
Download Patient Form
Below, you'll be able to download our patient form. Please fill out, print, and bring it on your next visit. It will save your time in our office.
Download Child Patient Form
Your initial appointment will consist of a consultation explaining your diagnosis and treatment options.
Occasionally, treatment can be done the same day as the consultation. However, a complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on another day.
Please assist us by providing the following information at the time of your consultation if possible:
- Your referral slip and any X-rays if applicable
- A list of medications you are presently taking
If you have medical or dental insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.
Contact Information
Address: 5929 Evergreen Way, Ste 100 Everett, WA 98203
Phone: 425.353.4469
Email: info@EverettChicagoDental.com
Office Hour: Mon - Thu: 9am - 6pm
Schedule your Visit