Evergreen Pediatric & Airway Dentistry

12910 Totem Lake Blvd NE #103, Kirkland, WA 98034

Estimate your child’s dental treatment costs with confidence and understand what factors influence pricing before making decisions.

Please Describe Your Child's Condition *

Please Explain "other"

How long has your child been living with this? *

0-2 years

2-5 years

5-10 years

Over 10 years

Do you have Dental Insurance? *

Yes

No

Does Your Child's Condition Have A Negative Impact On Thier Ability To Eat or Chew Certain Foods? *

Yes

No

What is the most important outcome you would like to see? *

Function - eating, chewing, talking

Aesthetics - beautiful, natural-looking teeth

Both are important

What has kept you from getting treatment? *

Time

Fear

Money

Can’t find the right dentist

How urgent is it for you to fix this problem? *

I’m not in a rush

Within 1-3 months

I want help now

Have you consulted with another dentist on this issue? *

Yes

No

Where Can We Send The Cost Estimate? *

Email

Phone Call

Text

First Name *

Last Name *

Email *

Phone *

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