Evergreen Pediatric & Airway Dentistry

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

425-814-3196

Kids Smile Quiz

Discover What Your Child’s Smile May Need

Tell us what's going on with your child's teeth *

How long have they been living with this? *

0-2 years

2-5 years

5-10 years

Over 10 years

Does Your Child's Condition Have A Negative Impact On Their 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

Which best describes the best way for you to pay for treatment? *

Dental insurance

Credit card

Check or debit card

Care credit

Choose Best Time To Call *

First Name *

Last Name *

Phone *

Email *

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