New Patient Forms
Franklin Family Dental Centre
New patient forms are provided for you directly on this page. Once you have completed this form, please fax it to us or bring it with you on the day of your first visit. It is important to us that you can save time so you don’t feel rushed on the day of your appointment.
There are two different patient forms, one for children and one for adults. The details you provide in this form are confidential. All the information is relevant in order for us to provide you and your family with personalized service to fit your needs and wants. It is important to complete all the questions including your current address, phone number, date of birth, health, and dental history. There is also a section that asks about dental insurance information. The insurance portion is there so we can direct bill your insurance company if you have coverage.
The personal information and protection act part at the end requires your signature, acknowledging our policy and procedures so you know what happens with the details you provide to us. Please take your time to read this portion carefully.
Do you have questions? Feel free to call us anytime and we will answer your concerns.