New Patient Forms

The following forms can be downloaded to your computer and printed at home.
By filling out these forms ahead of time you will save significant time of 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.

Fax: (416) 767-0842


Download
Patient_Information.doc 44 KB
Patient_Information.pdf 466 KB
dental
Patient_Health_History.doc 249 KB
Patient_Health_History.pdf 395 KB
dental
Patient_Consent_Form.doc 45 KB
Patient_Consent_Form.pdf 443 KB
dental
Dental_Questionnaire.doc 194 KB
Dental_Questionnaire.pdf 342 KB
dental
Childrens_Dental_Questionnaire.doc 194 KB
Childrens_Dental_Questionnaire.pdf 345 KB
dental
Financial_Agreement.doc 37 KB
Financial_Agreement.pdf 563 KB


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 our forms.

Pacific Dental - Dentist in High Park, Toronto

Dr. D. Sacoransky

Address: 6 Pacific Avenue, Toronto, ON, M6P 2P3
Phone: (416) 762-9706
Fax: (416) 767-0842
Email: info@pacificdentalonbloor.com

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