New Patient Registration Form

Thank you for your interest in becoming a patient at Downtown Sleep Dentistry and Oral Surgery. Please fill out the following form to ensure we have all of the required information when you come to our downtown Hamilton dentist office for the first time. If you have any questions or concerns regarding the registration form, please contact us or give us a call at 905-528-8959. 

    • Parent/Legal Responsible Consent Provider

    • Same as above

    • Primary Insurance Information:

      • Name of insured

    • Secondary Insurance Information:

      • Name of insured

    • Referral Information

    • Referring dentistFacebookGoogleFriend/PatientRadio AdMailer