New Patient Forms

We provide gentle and compassionate care in a friendly environment. We always focus on evidence based diagnosis, patient education, and working with you to build a treatment plan that aligns with your oral health goals.

REQUEST AN APPOINTMENT

or call (778) 738-5111

New Patient Intake Form

We want your first visit to go as smoothly as possible, which is why we’ve made our New Patient Forms available for you to download online by clicking here.

NEW PATIENT INTAKE FORM
1 Step 1

Please fill out the new patient intake form below with as much information as possible. 

Checkbox
Are you allergic to any medications? (Please select from below if yes)
Do you have, or have you had any of the following:

If taking medications, supplements, and/or vitamins please list below:

Is there any additional information regarding your health we should know about as your dentist?

Main Dental Concern?

Dental History

Do You Have Dental Insurance?

Any details to add?

Emergency Contact Information

We kindly request 2 business days to cancel or reschedule an appointment. Short notice cancellations will be subject to a $75 finepick one!

Patient or Parent Signature

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New Patients are always welcomed at our practice!

Give us a call or fill out the form below and one of our friendly team members will be happy to help you!

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