Post-Treatment Care at Home

 

 

 

 

 

 

Patient Zone • Appointment form

To make an appointment, call 514-932-8585 or follow the procedure below.

To make an appointment on line:

• Select the type of consultation you need
• Choose the day and time that are convenient to you
• Give us your complete contact information
• Fill out the form to open a medical file if this is your first visit

We will call or e-mail you as soon as possible to confirm your appointment or offer you another date and time.

Make an Appointment
Appointment date: Year: 
Preferred time of day for appointment: 
Please confirm my appointment by:
email (telephone) home (telephone) home
Comments, questions?

Personnal information:
First name:*
Last name:*
Gender: 
F  M   Age: 
Adress:*
  City:*    Postal code:* 
Home (telephone):*
Work (telephone):*
 ext: 
E-mail:

Thank you for taking the time filling in this form. We are looking forward meeting you on your next meeting.

 
Document sans titre
Appointment
 


ServDentist Web solutions by InfoSign Media Inc. SEO by Vertigo Media Inc.