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