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Please use this convenient form to request an appointment. We will make every effort to get back to you as soon as possible to schedule your visit. [For emergencies please call (613) 686-3898]

 
  Full Name of Patient:    
     
       
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  Phone number where we can reach you:    
     
       
  I am an:    
  Existing patient New patient    
       
  Preferred days of the week that you can see us:    
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  What is the purpose of your visit?:    
     
       
     
       
   
       
Creating Beautiful Smiles, caring cosmetic dentistry in spa confort

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525 Legget Drive, Suite 120, Brookstreet Hotel Lobby • Ottawa ON  K2K 2W2