Register/Update Your Information

If you are interested in becoming a new patient or would like to update your information, please fill the form below or call us at 604.552.1018. The following information will help us to start a chart with insurance coverage (if applicable) before you arrive at your next appointment.

For your convenience we accept most insurance dental plans as well as Visa, Debit and cash payment options for the portions that are not covered in your plan. We are able to provide estimates for any procedures, upon request. If you reach the maximum of your dental plan, we offer financing so you can get the healthy smile you deserve.

Name*
First Last
Phone*
Email*
Is this your first time?*
- Yes, I would like to register
- No, I am just updating my information
Birthdate*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Insurance Provider
Insurance ID
Message
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