#208 - 3929 8th St E, Saskatoon, SK

New Patients

(Children 10 and Under)

Please fill out the form below.

Patient Name:
Date of Birth:
Address:
Address:
Address:
Subscriber's Date of Birth:
Subscriber's Date of Birth:

Please bring your insurance card(s) to your appointment.

Patient Intake / Medical History

Has there been any change in your health in the past year?
Are you currently under the care of a physician?
Are you pregnant or nursing?
Do you have any of the following?
Do you have any allergies (medications or other)?
Do you smoke or vape?
Do you drink alcohol?
Do you use cannabis?
Do you use other recreational drugs?

Dental Questionnaire

1. Have you had any of the following?
This is to certify that I, undersigned, consent to the performing of the dental and oral surgery procedures agreed to be necessary or advisable, including the use of local anesthetic as indicated and I will assume responsibility for fees associated with those procedures. I acknowledge reviewing the College Park Dental Privacy Policy and understand my rights of privacy and respect to me (and any dependent children) personal information. I further consent to the collection, use and disclosure of my (or dependent child’s) personal information. Please check the following boxes.
Consent(Required)
Date:
This field is for validation purposes and should be left unchanged.

Proudly serving Saskatoon and area since 1986.

Book an Appointment

#208 – 3929 8th Street E.,
Saskatoon, SK  S7H 5M2

Clinic Hours

Monday – Friday:   
8:00 am – 4:00 pm

Saturday – Sunday: 
Closed

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