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Name
First Name
Last Name
Email
*
Phone
*
Age Range
*
Younger than 5
6 to 10
11 to 17
18 to 21
Older than 22
Are you a patient of our clinic?
*
No, I am a new patient.
Yes, I am an existing patient.
Have you completed our New Patient Form?
*
Yes
No
Complete our online New Patient Form to save you time at our clinic!https://erinridgedental.ca/new-patient-form/
Preferred Days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Preferred Time
*
Morning (8-12)
Early Afternoon (12-3)
Late Afternoon (3-6)
What Dental treatment are you interested in?
*
Dental Exam
Hygiene
Children's Dentistry
Fillings
Bridges
Crowns
Implants
Veneers
Braces, Myobrace and Invisalign
Sleep Apnea
TMJ Treatment
Teeth Whitening
Other...
What else can we help with?
*
Do you have anymore information to help us book you more accurately?
About Us
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Expand
Our Dental Office
Our Dentists
Expand child menu
Expand
Dr. Brandon Earl
Dr. Alana Dupuis
Blog
Services
Expand child menu
Expand
Orthodontics
Expand child menu
Expand
Invisalign
Myobrace
Braces
Orthodontic Fees
Sedation Dentistry
Children’s Dentistry
Dental Hygiene
Contact
Expand child menu
Expand
Contact Us
COVID-19 Patient Consent Form
X-Ray Release Form
New Patient Form
Our Forms
