Referred by Dr.

First Name *

Last Name *

Dentist Phone Number *

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Effective May 14, the Alberta Government and with protocol from The Alberta Dental Association and College, we are now able to return to a full provision of services. Please complete the COVID screening form for each person entering the office. This form must be completed each time you come for an appointment.

Prescreening & Consent Form

Doctor Referral Form

Referred by Dr.

COVID 19 PRESCREENING