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.

Download
Patient_Information.doc 36 KB
Patient_Information.pdf 36 KB
dental
Patient_Health_History.doc 236 KB
Patient_Health_History.pdf 236 KB
dental
Patient_Consent_Form.doc 36 KB
Patient_Consent_Form.pdf 36 KB
dental
Dental_Questionnaire.doc 180 KB
Dental_Questionnaire.pdf 180 KB
dental
Childrens_Dental_Questionnaire.doc 188 KB
Childrens_Dental_Questionnaire.pdf 188 KB
dental
Financial_Agreement.doc 30 KB
Financial_Agreement.pdf 46 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. David Sacoransky & Dr. Ivan Kominek

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

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