Emergency Dental Clinic
Call us today 780-250-0877

New Patient Forms

By filling out these forms ahead of time you will save significant time on your visit. If you have any questions when filling out the form, please do the best you can, and our staff will assist you with your questions on the day of your appointment.

Digital New Patient Forms

The following forms can be filled and submitted online form any device (phone, tablet, laptop or desktop).
At the end use your finger or mouse to sign the forms digitally.

Online Version
  Medical/Dental History
  Personal Information Consent
or

Fillable and Savable PDFs

The following forms can be downloaded to your computer, please complete the information and bring them with you to your first visit. You may also fill out this electronic forms, save and send the completed PDF files.

Fillable and Savable PDFs
  Dental/Medical History
  Records Release

Technical Note:
Our online forms use the Adobe Acrobat Plugin.
Please download the free plug-in from Adobe's website if it is not already installed on your system. It is important that you have the latest version, in order to open, fill and save our forms.

  Get Adobe Reader

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Located in Summerside/Ellerslie in southside Edmonton.
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