Book Appointment - Paris Dental Centre

Local: 519-442-4452 Toll-Free: 1-844-442-4452 SMS: 226-270-5729

Patient Referral

Book Appointment

Request Callback

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Date of birth *

Phone number *

Type of phone number *

Home
Cell
Work

Email *

Preferred contact method? *

Phone
Email
SMS
Mail

When should we contact you? *

Requested appointment day? (We will do our best to accommodate) *

Appointment type? *

Are you an existing patient? *

Yes
No

Additional information (Dental anxiety? Allergies? Appointment type?)

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