Dental history and medical questionnaire (new patients)

You are a new patient?

Prior to your first visit, you must complete a form which details your dental history and a questionnaire about your health condition. To speed up the process, we invite you to proceed at home, before your first appointment at the clinic:

Download your dental history (PDF)

Download your medical questionnaire (PDF)

Save the forms on your computer BEFORE you fill them in, otherwise your information will not be saved.

Subsequently, fill out the form directly on your computer.

To submit, you have two options :

  • Print them out and hand them to the receptionist upon arrival, along with your full list of medications or;
  • Send them by email at info@centredentaireboulos.com

In case of cancellation of appointments, please notify us by phone or email at least 48 working hours in advance.

Thank you.

** Note that Centre dentaire Boulos will not be held responsible in the event of loss of information, identity theft or any other situation that may occur following the emailing of your forms.