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Lake Union Family Dental
Geoffrey D. Seuk, DDS, PS
Creating Beautiful Smiles

Appointment Request

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.  Registration forms are available for download below.  If you would like to request any dental records from previous dental offices, A records release form is also available.  When an appointment has been scheduled, please arrive 20 minutes prior to your scheduled time so that we may process your paperwork.  Thank you.

Please do not use this form to cancel or change an existing appointment.

*If you are a new patient, please call to schedule your first visit.

New patient registration forms: New Patient Forms.pdf

Records release form: Authorization to release info.pdf

*Items in bold are required.


Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

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Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.