New Patient Forms

We want to thank you for visiting Thomas R. Quickstad, DDS website! Our goal is for your first visit to be a positive experience.

Help us create a smooth experience. Fill out the New Patient forms before your first visit.

We will take the required time to properly diagnose your immediate dental concerns, review your past medical and dental history, and create a treatment plan that provides for your optimal dental health.

Dentist accepting new patients in Issaquah, WA

Please click on the links below our Patients forms.

Dental Patient consultation

Your First Visit

A dental patient at our Sammamish office can expect their initial appointment to consist of an examination and review of your treatment options. 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:

  • Any x-rays taken by a previous dentist, if applicable.
  • A list of medications you are presently taking.
  • If you have dental insurance, bring the necessary completed forms. This
  • will save time and allow us to help you process any claims.


  1. Please alert our Sammamish dental patient office if you have a medical condition that may be of concern prior to treatment (i.e., diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are currently taking any medication (i.e., heart medications, aspirin, anticoagulant therapy, etc.).
  2. All patients under the age of 18 must be accompanied by a parent or guardian.
  3. If your dentist or physician has taken x-rays, you may request that they forward them to our office. If there is not enough time, please pick them up and bring them to our office. If additional x-rays are necessary, they can be taken at our facility.
Patient PortalMobile App Download

Financial Policy

Patient Billing

For your convenience, we accept Visa, MasterCard, and Discover. Our Sammamish dental patient office delivers the finest care at a reasonable cost. Payment is due at the time service is rendered, unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at Thomas Quickstad, DDS, PLLC Phone Number(425) 391-1331. Many times, a simple telephone call will clear any misunderstandings.

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Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.

Most insurance companies will respond within four to six weeks. If you have a balance on your account you will receive a monthly statement. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated.


Dental Claims Filing

We are happy to assist you in filing dental insurance claims. Patients with dental insurance should bring a dental insurance card to their first appointment. We submit the claim to the insurance company, but require that the patients pay the uninsured portion (patient portion) at the time of service.

Insurance companies are obligated to you and not the doctor. For this reason, patients must take responsibility for their own claims. If an insurance carrier has not paid on a claim 60 days after it has been submitted, the balance for that claim will be the patient’s responsibility.

Sammamish dental patients without dental insurance are required to pay in full at the time of service.

Dental insurance plans we are contracted with:

Note: We can process claims for most dental insurance companies.

  • Delta Dental – PPO
  • Regence – PPO
  • Premera – PPO
Payment Options
  • Cash Discount: Pay upfront with cash and receive a discount.
  • Check or Credit Card: Always accepted.
Other Options
  • CareCredit: Apply online ( or in our office.

Make a payment

We offer convenient payment options. You can now pay your balance any time of day or night with our secure online payment portal. We accept most major payment methods.

Please Note: Payment is due at the time of service.

As a courtesy to you, we will bill your insurance company and track claims. Please keep us informed of any changes to your insurance plan. You are responsible for the fees charged by our office, no matter what your insurance coverage may be. Most insurance companies should respond to the claim within four to six weeks. Any remaining cost is your responsibility.

Dentistry Care You Will Love
Dental tools

Latest Technology

Perfect tooth

Lasting Results

Dental care

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Pain-Free Care

You can now get a hold of us easier and faster than ever! Text us

(833) 272-1969
Schedule Your Routine Care Today

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