New Patient Package

Welcome to NEW PATIENT PACKAGE section. We are delighted to work closely with you for all aspects of prosthetic dentistry, implant dentistry, cosmetic dentistry, oral surgery, periodontics, and endodontics. We are also available to help you decide which would be the best option for your particular cases.

You can fill out the NEW PATIENT forms below or directly contact our Vancouver office at 604-336-0958 to discuss a case and refer a patient.

COVID-19 Pandemic Patient Risk Acknowledgement

New Patient Medical History Form

Consent For Internet Communications

Photography Release

Patient Online Web-Forms

    Patient Information

    Date of Birth:
    Radiograph:

    EmailedTake new
    Please arrange the requested Consult/Treatment and refer the patient back.
    Consult OnlyConsult and Treat

    Relevant important Medical and Dental history:

    Tooth/Site:
    Reason for Referral:

    Oral SurgeryPeriodonticsImplantEndododonticsProsthodontics

    Cone Beam CT Acquisition:

    Full ArchDouble Arch


    Patient information will be used by Vancouver Dental Specialty Clinic for the sole purpose of returning your request to be contacted by us. Vancouver Dental Specialty Clinic takes no responsibility for web communication.

    3488 West Broadway

    Vancouver, BC, V6R 2B3

    604-336-0958

    Call us!