North York Dentist | North York Dental Office

416-223-2453 | Contact | Hours

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Existing patient information changes and updates form

Existing patient information changes and updates form

Please fill below to update our patient files prior to your appointment.

MM slash DD slash YYYY
Name:
Current or updated address:
If applicable, do you still have dental insurance?
If so, has anything changed at all with your dental insurance?
Max. file size: 64 MB.
Are you currently taking any medications/vitamins?
Max. file size: 64 MB.
Have there been any changes to your health in the past 2 years?
Have you contracted Covid-19 in the past 3 Months?
Have you received your 1st covid-19 vaccine?
Have you received your 2nd covid-19 vaccine?
Have you received your Booster (3rd dose) vaccine?

Thank you for taking the time to update your information.

Patient name:
MM slash DD slash YYYY

Once fully read and reviewed, please make sure that the above document is filled out appropriately. By signing below and submitting this document, we are assuming that it has been read in its entirety. All patient signatures will be verified for authenticity in the office.

Contact

PHONE: 416-223-2453

ADDRESS:139 Finch Ave. West Along Finch Ave. between Bathurst St. and Yonge St.

EMAIL:

info@newtonbrookdentistry.com

Location

Hours

  • Mon9:00am -5:00pm
  • Tues8:00am-6:00pm
  • Wed8:00am-7:00pm
  • Thu 9:00am-8:00pm
  • Fri   9:00am-3:00pm
  • Sat 9:00am-3:00pm
  • Sun-closed-
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