I, the undersigned, understand that the information contained in the medical and dental history is important to my treatment. I certify that all of the information I have completed is correct and I have not knowingly omitted data. I consent to the release of medical information from my medical doctor or other health care services provider as is required by this dental office. I authorize this dental office to perform diagnostic procedures as may be required to determine necessary treatment. I understand that it is my responsibility to pay for dental treatment for both myself and my dependents. I assume all responsibility for fees associated with my dental treatment or dental diagnostic procedures.
Thank you for choosing US!
Please note that once you have booked an appointment with us it means that we have reserved time in our schedule exclusively for you. If you cancel your appointment less than 48 hours before it is scheduled to take place, you will be subject to a cancellation/rebooking fee of $50.
To avoid a cancellation fee, please provide cancellation notice at least 48 hours prior to your appointment.
You can cancel or reschedule an appointment by emailing us at info@kingandwestondental.ca or calling our office at 416-241-5038.