Patient information

New patient form

Welcome to Pickering Square Dental. Completing the new patient form before your visit gives the dental team time to understand your contact information, health history, medications, allergies, dental concerns, and benefit details.

Complete it securely online before your visit — it saves time at the front desk.

New Patient Form

Secure online form · complete before your visit

Complete the form onlinePrefer paper? Download the PDF

Submit the online form before your visit. If you choose the paper PDF, bring the completed copy to the office. Do not email health information to the general office address unless staff specifically instruct you to use an approved secure method.

What information should I have ready?

Your legal and preferred name, date of birth, address, phone, and contact preferences.
Emergency-contact information.
Current medications and supplements, including dose when known.
Allergies and previous reactions to medications, latex, dental materials, anaesthetic, or sedation.
Medical conditions, surgeries, pregnancy status, and the names of relevant healthcare professionals.
Dental symptoms, past treatment, previous X-rays, and concerns about anxiety or comfort.
Private dental-benefit, government-program, or CDCP member information.

If anything changes between completing the form and the appointment, tell the team when you arrive.

What should I bring to the first appointment?

Bring identification, your coverage information, and a medication list. If you choose the paper PDF, bring the completed copy too. If you use an inhaler, glucose monitor, mobility aid, communication device, or medication that may be needed during the visit, bring it as directed by your healthcare professional.

Ask the office if recent dental records or X-rays should be transferred before the appointment. New diagnostic images are recommended only when the dentist determines they are needed based on your history, examination, and the information already available.

What happens next?

01

A conversation, then an examination

The first visit usually begins with a conversation about your goals and concerns, a health-history review, an examination, diagnostic records when indicated, and a discussion of findings.

02

Treatment is not assumed to begin immediately

Urgent needs, the complexity of care, available time, and informed consent can affect what is completed at the initial visit.

03

Consent, interpreting, and support needs

Parents or legal guardians should contact the office about consent and documentation for a child or dependent adult. Interpreting, accessibility, and support-person needs are easier to coordinate when the office knows in advance.

Where to next

Continue with helpful information for planning your next visit.

Call (905) 420-1777 if you have a question about the form, records, consent, or what to bring.

Patient information
New patient form

Welcome to Pickering Square Dental. Completing the new patient form before your visit gives the dental team time to understand your contact information, health history, medications, allergies, dental concerns, and benefit details.

New Patient Form

Secure online form · complete before your visit

Complete the form onlinePrefer paper? Download the PDF

Submit the online form before your visit. If you choose the paper PDF, bring the completed copy. Do not email health information to the general office address unless staff instruct you to use an approved secure method.

What information should I have ready?

Legal and preferred name, date of birth, address, phone, and contact preferences.
Emergency-contact information.
Current medications and supplements, including dose when known.
Allergies and previous reactions to medications, latex, dental materials, anaesthetic, or sedation.
Medical conditions, surgeries, pregnancy status, and relevant healthcare professionals.
Dental symptoms, past treatment, previous X-rays, and concerns about anxiety or comfort.
Private dental-benefit, government-program, or CDCP member information.

If anything changes between completing the form and the appointment, tell the team when you arrive.

What should I bring to the first appointment?

Bring identification, your coverage information, and a medication list. If you choose the paper PDF, bring the completed copy too. If you use an inhaler, glucose monitor, mobility aid, communication device, or medication that may be needed during the visit, bring it as directed by your healthcare professional.

Ask the office if recent dental records or X-rays should be transferred before the appointment. New diagnostic images are recommended only when the dentist determines they are needed based on your history, examination, and the information already available.

What happens next?

01

A conversation, then an examination

The first visit usually begins with a conversation about your goals and concerns, a health-history review, an examination, diagnostic records when indicated, and a discussion of findings.

02

Treatment is not assumed to begin immediately

Urgent needs, the complexity of care, available time, and informed consent can affect what is completed at the initial visit.

03

Consent, interpreting, and support needs

Parents or legal guardians should contact the office about consent and documentation for a child or dependent adult. Interpreting, accessibility, and support-person needs are easier to coordinate in advance.

Where to next

Continue with helpful information for planning your next visit.

Call (905) 420-1777 with a question about the form, records, consent, or what to bring.

Secure online intake

Complete your new patient form online

The five short steps cover patient details, benefits, dental history, medical history, and your smile goals. You can review your answers before submitting.

Your private health details stay out of email notifications. The clinic receives a notice that an entry is ready and signs in to review it. Do not enter SIN, driver’s-licence, credit-card, or banking information. This form does not schedule an appointment.

Step 1 of 5 - Patient details

  • This field is for validation purposes and should be left unchanged.
  • Step 1 of 5 — Patient details

    Please complete this secure form before your first appointment. Fields marked with an asterisk are required. This submission is not an appointment request.

  • About the patient

  • Home address

  • Emergency contact

  • Visit details

  • Tell us about anxiety, accessibility, communication, or support-person needs.

Canadian Dental Care Plan

NOW ACCEPTING CDCP PATIENTS • ALL AGES

The Canadian Dental Care Plan (CDCP) is now open to eligible Canadian residents of every age, and applications for the 2026–2027 benefit year are open. You may qualify if your adjusted family net income is under $90,000, you have no access to private dental insurance, you are a Canadian resident for tax purposes, and you have filed your latest tax return. Pickering Square Dental welcomes CDCP patients — cleanings, exams, fillings, and more.

Open to All Ages
Family Net Income Under $90,000
No Private Dental Insurance