Health Questionnaire (new patients)

Are you a new patient? Looking to take an appointment? Before your appointment, you will be required to complete a health questionnaire relevant to your current health status, previous medical history, as well as answering questions about your dental health and history.
To help accelerate the process, we invite you to fill out the health questionnaire at home prior to your first visit.

  1. Save the document to your computer
    * DO NOT COMPLETE THE FORM DIRECTLY ON THE WEB BROWSER*
  2. Print & Complete form.
  3. Bring to your next appointment
    OR
    send it to us by email at info@passionsourire.com

In case of cancellation, please notify us by phone or email at least 2 days in advance, otherwise, service fees will apply.