SIGNATURE 28 FORMS

FOR NEW PATIENTS + REFERRING DENTISTS
IMPORTANT NOTICE

We collect information from our patients about their health history, their family health history, physical condition and dental treatments. (Collectively referred to as “Medical Information”). Our patients’ medical information is collected and used for the purpose of diagnosing dental conditions and providing dental treatment. All the information collected remains private and confidential. If you have any questions or concerns about our policy please contact us at 403.228.5311

NEW PATIENT INTAKE FORM

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REFERRAL FORM FOR DENTISTS

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