Patient Application Form

 
1 2 3 4 5 6 7
Page 1 of 7

Here are some important facts to know before you register:

  • The clinic is open to everyone over 18 years of age and orthodontic patients under the age of 35.
  • All prospective patients must first attending a screening appointment prior to being accepted as new patients*. We are a teaching institution where patients are selected based on the requirements of our educational program. Please be advised that patients with limited treatment needs (i.e. less than 4 fillings, no need for crowns, root canal treatment, denture, etc.) are not likely to be accepted for treatment in our clinic.
  • We treat emergency cases on a priority bases. Limited space is available. Please refer to Emergency services page.
  • Due to high volume, patient registration is subject to "black-out" periods and waiting time for a screening appointment can vary.
  • The clinic is open from September to the end of May.
  • Patients must be able to attend appointments at least once every 2 weeks for 3-4 hours.
  • People receiving social assistance or covered by medicare (RAMQ) are not covered in our clinic.
  • Fees are based on the recommendations of the Association des chirurgiens dentistes du Québec.

* Patients requiring root canal treatment that has been diagnosed by a dentist are accepted on a priority basis and may not need to undergo this examination.

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit tar zip.
Back to top