New Patient Appointment Request

If you are a current patient with our practice, please call our office at (416) 323-1717 to schedule your appointment.

The first step toward achieving a beautiful, healthy smile is to schedule an appointment. To schedule an appointment, please complete and submit the request form below. Our scheduling coordinator will contact you soon to confirm your appointment.

Please note this form is for requesting an appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly.

Contact Information:

Bold Fields are required.

Your Name First and Last

Your Email Address

Address Line 1

Address Line 2

City Province/State

Postal Code/Zip Code

Phone Number

Alternate Phone Number

Are You A New Patient?

Were you referred by a current patient?

Please provide the patient's name so we can thank them Patient's Name First and Last

Appointment Preferences: Please Describe the Nature of Your Appointment:

periodontics | implants | esthetics