Welcome to Olde Oakville Dental


  Contact : 905.829.1666

New Patient Form

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The information in this confidential questionnaire is essential in rendering our high standard of professional care.  Please feel free to ask for assistance.

 

Present State of Health

 

Cardiovascular - Respiratory - Blood

 

Nervous System

 

Metabolic - Endocrine

 

Genito-Urinary

 

Additional

 

Past Medical History

OFFICE FINANCIAL POLICY
Our fees are determined by the dentist in accordance with guidelines provided by the Ontario Dental Association.  All fees are charged directly to the patient and patients are PERSONALLY RESPONSIBLE for payment of bills.  We will gladly help you to complete any dental benefits forms, help you to understand and maximize your dental benefits and submit predeterminations on your behalf.

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