Waites Family Dental
*Positive responses to any of these would likely indicate a deeper discussion with Dr. Waites before proceeding with elective dental treatment today.
By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.
Click a signature you want to use:
Copyright © 1999-2021 Hush Communications Canada Inc.