First visit to dental clinic

New patient form

We invite you to fill out a first-visit form to help speed up the process of your first visit.

To provide you with the most professional service possible, and to ensure you receive the best dental treatment, we require a detailed history of your general and dental health. For this, we need a few important details about your health, dental history, and any medications you may be taking.

To speed up the process of your first visit, we suggest you download and fill out the first-visit form. You can fill the form out in advance in the comfort of your own home or at work with all of your information at hand.

Procedure to follow

  1. Download the form (PDF format) by clicking on this icon: W3Schools
  2. Print it out.
  3. Fill out the form (print clearly and use a ballpoint pen).
  4. Do not send the form by email (your email may not be secure).
  5. Bring the form with you to your first appointment.
  6. Bring your dental insurance information if you have it.
new patient, Centre dentaire Vaillancourt St-Onge

The information you provide, of course, will remain strictly confidential; it will not be disclosed to anyone without your written permission.

If you are unable to attend an appointment, you must cancel your appointment 48 hours prior to the scheduled time, otherwise you will be charged a cancellation fee for not showing up — and this fee will need to be paid before your rescheduled appointment.

Make an appointment now!

(450) 582-2219 Appointment