Are you looking to join a new dental clinic for ongoing care?
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Please select an option
Yes, I want a new dentist for ongoing care
No, I just need help with a specific issue
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What brings you here today?
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New patient exam and cleaning
Tooth pain or discomfort
Sensitive or bleeding gums
Jaw pain or teeth grinding
Cavity or filling
Broken or chipped tooth
Root canal
Crown or cap
Tooth extraction
Missing tooth or implant
Braces or Invisalign
Teeth whitening
Veneers
Something else
How do you feel about your oral health?
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I take good care of my teeth
I maintain it regularly
I know I need to improve
What are your goals for your smile?
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Cleaner mouth
Whiter teeth
Fresh breath
No cavities
Healthier gums
Better looking smile
When was your last dental visit?
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Less than 1 year ago
1 to 2 years ago
More than 2 years ago
I have never been
How do you feel about visiting the dentist?
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Not nervous at all
A little nervous
Moderately nervous
Very nervous
Extremely nervous
Be honest. We can adjust your experience.
What time works best for you?
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Early morning
Morning
Midday
Afternoon
Evening
Weekends
Choose all that fit your schedule.
How soon would you like an appointment?
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As soon as possible
Within a week
Within two weeks
Just exploring for now
Do you have dental insurance?
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Yes, I have insurance
No, I will pay myself
Who is your insurance provider?
Sun Life
Manulife
Canada Life
Green Shield
Blue Cross
Desjardins
Other
Claim your free $50 dental reward
Claim you reward
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Yes
Skip it, i don't want it