New Patient Registration

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New Patient

PERSONAL INFORMATION


INSURANCE INFORMATION


EMERGENCY CONTACT


MEDICAL HISTORY


Have you ever experienced any of the following jaw problems?


Do you have any of the following habits?


Have you ever had any of the following?


INFORMED CONSENT FOR EXAMINATION, GENERAL AND SPECIFIC


Ontario Dental Association
Royal College Of Dental Surgeons Of Ontario
American College of Prosthodontists
Association Of Prosthodontists Of Canada
Association Of Prosthodontists Of Ontario
Association Of Prosthodontists Of Ontario
West Ajax Dental

CONNECT WITH US


(905) 683-3700
info@westajaxdental.ca

2892781759

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VISIT US


West Ajax Dental
73 Old Kingston Rd,
Ajax, ON
L1T 3A6

HOURS OF OPERATION


Monday: 7:30 am - 5:30 pm
Tuesday: 10:00 am - 8:00 pm
Wednesday: 10:00 am - 8:00 pm
Thursday: 7:30 am - 5:30 pm
Friday: By Appointment Only
Saturday: By Appointment Only
Sunday: Closed

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