New Patient Forms 

Due to COVID-19, we are looking to reduce the amount of commonly touched surfaces in the clinic. This includes paper, pens, clipboards, etc.

Please take a moment to fill out the required new patient forms before your visit. All 4 links will need to be completed. 

  1. PERSONAL INFORMATION, INFORMATION CONSENT FORM, AND INSURANCE INFORMATION
     

  2. MEDICAL HISTORY
     

  3. COVID-19 CONSENT
     

  4. FINANCIAL POLICY 
    required to be filled out if taking assignment of benefits
    Please note, if we are direct billing your insurance, we will require to keep a credit card on file. We will collect this information on the day of your appointment.

Below are the forms that will be signed when you come in to the office for your appointment. Make sure to review these before your appointment. 

General Anesthesia/IV Sedation Consent Form
required if having treatment done under general anesthesia or IV sedation
 

Local Treatment Consent Form
required if having treatment done under local anesthetic

Until further notice, all patients must enter at the back of the building. We also cannot accept any walk-ins.

 

The following will apply for all patients who attend an appointment at our office:

 

  • please text us at 780-413-0824 when you arrive and we will tell you when to come in to the building. Please do not enter unless you were told to.

  • only the patient is allowed in the building EXCEPT

    • if the patient is a minor; only one parent is allowed to accompany the patient

    • if the patient is an adult and is being sedated; only one escort is allowed to accompany the patient

  • the parent/escort will be asked to wait in the waiting room for the duration of the appointment. To manage patient flow, we are asking all escorts to remain in the waiting room.

  • there will be instructions on the back door when you arrive, but the instructions are as follows:

    • Patient & Escort 

      • ​you will be required to wear your own face mask

      • use hand sanitizer next to the door on your right hand side 

    • Ring the doorbell when you are ready and we will let you in to the waiting room and escort you to your designated spot 

  • Grey Facebook Icon

Copyright © 2020 | Privacy Policy

10835 124 Street

Edmonton, AB

T5M 0H4

ph: 780-413-0824

f: 780-482-0560

Monday 8:00am - 4:00pm

Tuesday 8:00am - 4:00pm

Wednesday 8:00am - 4:00pm

Thursday 8:00am - 4:00pm

Friday 8:00am - 4:00pm