Medical form (new patient)

Are you a new patient?

You must first complete a form collecting details about your condition before your first appointment at the clinic. To speed up the process, we invite you to fill out this form at home:

Download the form (PDF) by clicking here

Save the form on your computer before filling it *DO NOT COMPLETE DIRECTLY IN YOUR WEB BROWSER

Fill out and print the form.

Bring the form to the first appointment OR

Email it to info@www.urgencedentairedemontreal.com

In case of cancellation of an appointment, please notify us by phone or email at least 48 hours in advance, otherwise you will have to pay a service fee.