2450 Neyagawa Blvd. Unit 1C, Oakville, ON L6H 7P4  (905) 257-1997

  • PATIENT INFORMATION

  • DENTAL INSURANCE INFORMATION

  • EMERGENCY INFORMATION

  • MEDICAL HISTORY

  • DENTAL HISTORY

  • CONFIRMATION

  • Benefits of Orthodontics include Aesthetics, Health and Function. Orthodontics is a service that provides an improvement in the appearance of the teeth, in the general function of the teeth, and in general dental health. Teeth, gums, jaws are an intricate body part and can fail to respond to treatment. If good oral hygiene is not practiced, tooth decay and enlarged gums can result. Joint discomfort and root shortening are observed in a small percentage of cases. Teeth change throughout our lifetime and there can be some movement of teeth and some change after treatment. I have read and understand this paragraph. I also understand that my diagnostic records may be used for educational and promotional purposes. I have truthfully answered all the above questions and agree to inform this office of any changes in my medical or dental history. In addition, I authorize Dr. Boersma to perform a complete orthodontic evaluation.
  • What's Most Important To You?

  • We consider your satisfaction to be of utmost importance, and this starts by personalizing your orthodontic experience. Please review the treatment aspects below and rank your top 3 treatment aspects from 1 to 3: