Shoreham Dental Brampton
New Patient Registration Forms
You can save yourself some time by filling out the form below prior to your dental visit:
New Patient Registration PDF Form:
Step 1 – Click on “New Patient Registration PDF Form” button below
Step 2 – Fill out the form
Step 3 – Save the form and email to: firstname.lastname@example.org
COVID-19 (Coronavirus) Screening
Questionnaire & Patient Acknowledgement Form
At Shoreham Dental, the health and safety of our patients and staff has always been our top priority. To ensure we are providing the safest environment possible to deliver dental care, we kindly ask you to please complete this brief questionnaire prior to your appointment. This has been mandated by the Royal College of Dental Surgeons of Ontario for everyone’s safety. We appreciate your help and understanding with this measure. If the answer to any of the following questions is YES, please inform our reception staff IMMEDIATELY for further instruction. Thank you.
If you are having any problems with the forms, please call us at (905) 459-7778 and we will gladly assist you.