Request Appointment
Please complete the appointment request form below. Our receptionist will contact you to confirm your appointment. For faster service, contact our office by phone (604) 688-3335
First Name
Last Name
Email
Phone Number
Are you an existing patient of the office?
Yes
No
Do you have dental insurance? (new patients only)
Yes
No
Best time for appointment
Morning
Afternoon
Evening
Doesn't Matter
Preferred day of the week (check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Doesn't Matter
Appointment Purpose (check all that apply)
New Patient Full Exam (Adult)
New Patient Full Exam (Child)
Cleaning
Specific Problem or Purpose (please specify below)
Comments or questions
500
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