ONLINE BOOKING

WELCOME TO OUR NEW PATIENTS. WELCOME BACK TO OUR RETURNING PATIENTS.

TO BOOK AN APPOINTMENT ONLINE, PLEASE COMPLETE THE FORM BELOW. YOU CAN EXPECT A RESPONSE USUALLY WITHIN 24-48 HOURS.

FOR AN IMMEDIATE RESPONSE OR TO BOOK AN APPOINTMENT AT OUR EARLIEST OPENING, PLEASE CALL US NOW AT 905-856-7999.

MAIN BOOKING FORM

NAME

First Name

Last Name

EMAIL ADDRESS

PHONE NUMBER

(###)

###

####

SERVICE

PLEASE SELECT THE REQUESTED APPOINTMENT OR TREATMENT BELOW

ARE YOU A NEW PATIENT

Yes

No

HOW SOON WOULD YOU'D LIKE THE APPOINTMENT

AS SOON AS POSSIBLE

IN THE NEXT 24 TO 48 HOURS

1N THE NEXT 1-2 WEEKS

I'M NOT SURE

I'M FLEXIBLE

PLEASE DESCRIBE ANY RELEVANT DETAILS OR NOTES YOU'D LIKE ADDED TO THE BOOKING

YOU DON’T HAVE TO WAIT FOR YOUR DREAM SMILE— “SOMEDAY” CAN NOW BE “TOMORROW”

WE ACCEPT ALL INSURANCE

WE ACCEPT THE REFUGEE DENTAL PROGRAM

WE ACCEPT THE CANADIAN DENTAL CARE PLAN

WE OFFER CUSTOMIZED PAYMENT PLANS

— COMPLIMENTARY CONSULTATION

— ORAL EXAM

— CLEANING

— POLISHING

— X-RAYS

— COMPLIMENTARY CONSULTATION

— ORAL EXAM

— X-RAYS

AND WHILE SUPPLIES LAST, ALL NEW PATIENTS WILL RECEIVE AN EXCLUSIVE WELCOME GIFT.