Summerland Dental Centre
300-13009 Rosedale Avenue Summerland, BC V0H 1Z0
250-494-9711
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New Patient Forms

Please fill out our online patient forms prior to your appointment, so we can best serve you.

Click the button below to proceed. You will be directed to register an account or login to your existing account.

MEDICAL DENTAL HISTORY
Office Policies for Patients
Referral Form

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Assessment

Anxiety Assessment
Epworth Sleepiness Scale
Sleep History Questionnaire
STOP BANG Questionnaire

Consents

Bone Graft Consent
Implant/Dental Prostheses Consent
Invisalign Agreement and Consent
Invisalign Treatment Agreement
Nitrous Oxide/Oxygen Sedation Consent Form
Patient Consent and Financial Obligation
Whitening Consent

Information

IV Sedation Information
Root Canal Information
Tooth Extraction Information

Instructions

Pre-Sedation Instructions
Whitening Instructions
Medication Instructions

Post Op

Implant Crown Post Op
Implant Post Op
Oral Surgery Post Op
RCT Post Op
Sedation Post Op
Sinus Lift Post Op
Sinus Surgery Post Op
Tissue Graft Post Op

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250-494-9711
250-494-9633
300-13009 Rosedale Avenue Summerland, BC V0H 1Z0
admin@summerlanddental.com

Business Hours

  • Monday8 AM - 5 PM
  • Tuesday8 AM - 6 PM
  • Wednesday8 AM - 6 PM
  • Thursday8 AM - 6 PM
  • Friday8 AM - 5 PM
  • SaturdayClosed
  • SundayClosed
  • For Christmas - Closed from 12/23 to January 2nd.
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