Thank you for trusting us with your dental care. We promise to do our best to provide you with the finest care available. If you have any questions, please do not hesitate to call us.
RESPONSIBLE PARTY (if different from patient)
We are happy to assist you in submitting your insurance forms. Please remember that no insurance company covers all dental fees and that your bill is your personal responsibility.
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.