We're sorry but the English section is currently under construction.

For more information, please contact us at: 819 772-4222.

patientdentiste

Patient Area

Patient information questionnaire.

To expedite the process before your first consultation, you may fill out the on-line medical questionnaire. Rest assured that this information will remain confidential.

  • Enter your first and last name.

  • / / Choisir une date.

    Enter your date of birth.

  • Entrer your contact information.

  • - -

    Enter your home phone number.

  • - -

    Enter your office phone number.

  • Enter the name of your employer.

  • Enter your main complaint.

  • Do you have dental insurance?

  • Enter the name of your dental insurance company.

  • Describe your unusual reaction to any drugs or medication.

  • What other surgery have you had?

  • Check any of the following which you have had or have at the present.

  • Enter any and all remarks that could be related to the previous question.

  •  

Clinique de parodontie de l’Outaouais

111 boul. St-Joseph
Gatineau (Quebec)
J8Y 3W7
Phone: 819 772-4222
Fax: 819 772-4222
Académie Canadienne de Parondontie
Top   î