Dental History Form

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Name*

First Last

Email*

When was your last check up and dental x-rays?*

How long since your last dental hygiene appointment?*

Please describe your chief concerns.*

Do you have any un-replaced missing teeth?

Yes

Do you wear a complete or partial denture?*

Yes

Do you have any Dental Implants?*

Yes

Do you have jaw joint pain?*

Yes

Is there anything else you would like to tell us about you?*

Ready to Book Your Visit?

If you are looking for a family dentist in SE Calgary who values comfort, communication, and personalized care, our team is here to help. Call White Oak Dental at (403) 249-0303 or request your appointment online. We look forward to welcoming you to our clinic.

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Providing general dental care to the SE communities of Canyon Meadows, Willow Park, Southwood, Maple Ridge, Lake Bonavista, Lake Bonaventure, Bonavista Downs and surrounding areas.

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