New Patient Form

中文版

If you are a NEW PATIENT, Please complete this form in advance of your scheduled dental appointment.

GENERAL INFORMATION
EMERGENCY CONTACT INFORMATION
MEDICAL HISTORY
DENTAL HISTORY
COVID-19 QUESTIONNAIRE
CONSENT TO DENTAL FEES
Atlas Dental does not accept assignment of dental insurance benefits (direct billing). This means that you, the patient, are responsible for payment at the time dental treatment is rendered. Our office will help you process any insurance claims and you will be reimbursed by your dental insurance directly. We accept debit card, Master card and Visa. If you require financial assistance, payment plan options can be arranged. Please speak us if you have any further questions or concerns.
CONSENT TO COLLECTION OF PERSONAL HEALTH INFORMATION
I have reviewed the above information that explains how your office will use my personal health information, and the steps your office is taking to protect my information. I agree that Atlas Dental can collect, use and disclose my personal health information as set out in the PRIVACY STATEMENT.

Atlas Dental makes contacting a Toronto Dentist easy!

Free Consultation

We offer free consultations and second opinions. Schedule a free phone consultation with our dentist or send us a message below.

Book a dental appointment online

With a few clicks of a button, you can schedule your visit at Atlas Dental. Use our online booking system to find an appointment time that suits you!

Call us by Telephone

Need to talk? Call us or schedule your complimentary phone consultation with our Dentist in Toronto. If you are having a dental emergency, our Toronto dentist is available from Monday-Sunday from 7:30am-11:59pm for emergency phone consultations.

Send us a message

Fill out the form below and we will reply by the next business day.