Referral Form

You may refer patients to our office by filling out our Referral Form.

Please click here to view and print a copy of our referral form.

There Are Many Ways To Contact Our Office

Mailing Address

John W. Distel D.M.D. M.S., Ltd
900 W. Route 22, Suite 160
Lake Zurich, IL 60047

Phone
847-842-8866

Fax
847-842-7501

Contact Us Today
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. If you are an existing patient, this contact form should not be utilized for communicating private health information.

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