Patients Forms | Empress Walk Dental

Thank you for choosing to book an appointment with us. To ensure we received your request, please complete this form and send it to us (please make sure all fields are filled before sending). Upon receiving your request, we will contact you to arrange and finalize your appointment on your best convenient day and time.

We welcome new patients

We are committed to save the environment and for this very reason we are in the process of switching to a completely paperless office.

All new patients are required to fill out the medical history form prior to meeting with our Dentists. To save time, you may download the attached zipped fillable PDF form and do one of the following:

Fill it out on your computer and bring the file on a USB key. To be able to fill this form and save it to your computer, you need the “Free Nitro PDF Reader program”. Download here.
Simply print it, fill it up and bring it with you on your appointment day. Thank you.

Click to Download the New Patients Form

Name*
Email*
Phone*
Address
Street Address Address Line 2 City Province Postal Code
Are you a current patient?
Financial arrangements by?
Preferred day(s) of the week for your appointment?
Date Format: MM slash DD slash YYYY
To allow us to thank the referrer, please tell us how did you hear from us?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):
Name
This field is for validation purposes and should be left unchanged.

Two locations

Downtown (647) 726-2100

North York (416) 250-8000

We welcome new patients