New Patient Forms

During your first dental visit we take our time to get to know you, your medical and dental history and your current oral health state. We perform a full and thorough examination of your teeth, gums and mouth, making sure there are no signs of disease or other dental problems. Our goal is to prevent dental disease, or at least catch it early enough, when it’s easy to control and treat efficiently.

Part of getting to know you and providing safe, personalized support involves reviewing your medical and dental history and your current oral health state. Certain medical conditions and medications and can influence your treatment protocols – so you will be asked to provide a list of your medications and their dosages (including vitamins and supplements).

All new patients must complete the form below with their personal information, insurance details, medical history and dental history before their first appointment at Holland Street Dental.

All your information is kept strictly confidential. Please refer to the privacy policy form below to understand how we keep, use and dispose of your information and your rights to change it.

New Patient Form
Please print, fill, sign and bring it to the office for your first visit
Communication authorization form
Please print, fill and sign this form to let us know you preferred ways of communication with us
Client Privacy Policy Information
Should you have any questions about the privacy of your personal data, please read this form

We are Here to Help You

Contact Info
300-107 Holland Street EPO Box 1758Bradford, ONL3Z 2B9
(905) 551-9522
Mon: ClosedTue: 10:00 AM - 7:00 PMWed - Thu: 10:00 AM - 5:00 PMFri: 10:00 AM - 6:00 PMSat: 9:00 AM - 5:00 PMSun: Closed
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