preloader

Shoreham Dental Brampton

Shoreham Dental Brampton

New Patient Registration Forms

You can save yourself some time by choosing from several options prior to your dental visit:

Option 1 – New Patient Registration PDF Form: Click on “PDF Form” button below; and, fill out the form, save and email to:
info@shorehamdental.ca

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 (416) 661-6117 and we will gladly assist you.

Dr. Nosente Bollo-Kamara

Dr. Nosente Bollo-Kamara

Dentist

Book a New Patient Visit for only $149.99! Limited time offer. Includes 3 units of scaling, exam and x-rays. Conditions apply.