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Contact Us!

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

 
 
Office location:
Mississauga
1077 North Service Rd.
Unit 10
Mississauga, Ontario
L4Y 1A6
Phone: (905) 279-1818

 

 

For patients wanting to register for the first time, please print forms below or email our receptionist, Barbara at reception@applewoodvillagedentistry.ca to request the forms sent by email for you to fill out on the computer and then printed.

New Patient Forms

  • Every form must be signed by patient/guardian/parent in ink.
  • Every member of the family needs a separate form.
  • You may also call us on 905 279 1818 to request forms by fax.
  • If you have dental insurance coverage, bring the actual insurance cards in for your appointment.

 

If you wish your prior X-rays or records to be transferred to our office, there is a “Release of Information” form that you need to sign and then we can fax it to your previous dentist.

If you wish for us to submit claims directly to your insurance carrier (most patients prefer it), then a simple document needs to be signed for consent. It is part of the new patient questionnaire, last page.

Or simply arrive 10 minutes early for your first appointment to fill it out on a clipboard.