Before Your First Appointment

Welcome to our practice!

During your first appointment we will register you as a patient by inputting your personal and insurance information in our system. The doctor will then discuss your background medical information and review the referral information sent by your referring dentist.

Please complete the following information so that we may begin to set up your profile before you arrive.

Some Windows based browser users may experience a problem when sending the form. If this happens to you don't worry - you can either email us your information directly to info@endoburlington.ca, or you may provide us with your information when you arrive at the office.

After you download the Medical History Form PDF, open it using Adobe Acrobat Reader. Then choose from the following options:

Print it out and fill in the form at home with a pen. Bring the completed form to your first appointment.
In Acrobat Reader fill in the highlighted fields on your computer or mobile device. Then print the completed form and bring it with you to your first appointment;
or email it to us at: info@endoburlington.ca

(Adobe Acrobat Reader is free to download here.)

We look forward to meeting you!

Before Your First Appointment

Please Complete your Personal Information

Secondary Insurance Information

Medical History

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