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We are always welcoming new patients.

Please take a moment to provide us with the following information so we can ensure your SCD experience is an easy one.

Child New Patient Registration Form

New Patient Registration - Children

Personal Information

This form must be completed in full. Please use N/A if not applicable.

Suite #, House #, Street Name, City, Postal Code



TO ESTABLISH YOUR ACCOUNT, PLEASE PROVIDE THE FOLLOWING INFORMATION:

Insurance Information

Dental History

YesNoMaybe
Toothache
Abscess
Filling
Freezing
Cold Sores
YesNoMaybe
Nail Biting
Grinds Teeth
Thumb/Finger Sucker
Bottle in bed
Is your child nervous about dental treatments?

Medical History

Sign Here

Electronic Submission and Communication Consent

Book an Appointment

Fill the form below to schedule your appointment or call (647) 953-4630 for emergency.
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