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Medical Questionnaire (new patients)

Are you a new patient?

Before your first appointment at the clinic, you must complete your medical questionnaire collecting the details relating to your state of health.

To get a head start, you may fill out the form at home, prior to your visit.

Download medical form (PDF)

Save the form on your computer before filling it out. DO NOT FILL IT OUT DIRECTLY FROM YOUR WEB BROWSER otherwise your information will not be saved.

Complete the form directly on your computer and save it on your desktop.

You have 2 options to submit your form:

  • Print and your form to the receptionist, along with your full list of medications, upon your arrival to the clinic for your first appointment OR
  • Send it by email to drejennifertardif@net-plus.ca

Should you need to cancel your appointment, please notify us by phone or email at least 48 working hours in advance.

Thank you.

 

** Note that Centre Dentaire Jennifer Tardif will not be held responsible in the event of loss of information, identity theft or any other situation that may occur following the emailing of your forms.