New Patient Interview Thank you for selecting us as your personal dental health care team. All of us at Paris Dental Centre are looking forward to meeting you at your scheduled visit. NEW PATIENT INTERVIEW: Our purpose in conducting this interview is to learn more about you, allowing our dental team to supply you with all of the important information you will need to make informed decisions regarding your dental health. Please complete this form and bring it with you to your appointment. PATIENT INFORMATION BUILDING RELATIONS: We like to treat our patients like family. Before we get to your dental health, we’d like to get to know you as a person.Name* First Last Address* Street Address City Postal Code Date of Birth* Phone Number*Type of Phone Number*HomeCellWorkEmail* Preferred Method of Contact*PhoneEmailPreferred Time of Day*MorningAfternoonEveningWhat would you like to share with us about yourself?What would you like to know about our dental practice?What would you like to know about your doctor?What motivated you to make an appointment with us?What are your thoughts about going to the dentist?What have your previous dental experiences been like?What do you like and dislike about your smile?Are your teeth as you would like them to be?What are your dental health objectives? Pain Free Keeping your natural teeth for a lifetime Fresh breath Bright, white smile Healthy gums Handle the problem correctly the first time Straighter teeth So that we may serve you personally and comfortably, which of the following are most important to you? On time from start to finish Ideal appointment times/days A clear understanding of problems and recommended solutions To know absolutely everything that is going on in your mouth, regardless of severity To handle only your most pressing needs To be informed of how you can enhance the appearance and overall whiteness of your teeth To be called after your visit to see how you are doing To be done with treatment sooner with longer appointments Multiple shorter appointments to complete treatment Booking next preventive appointments in advance We are a zero-balance office. If there is an investment in your dental health, which method of payment is best for you?CashChequeCredit CardDebit CardInterest-free financingWe like to reward our patients who refer their friends, family, and co-workers. Which referral reward would you prefer? Gift certificate to Tim Hortons Subway Movie pass What expectations do you have of us?Do you have any other questions?