dent-intake-03

New Dental Patient Intake

New Patient Intake form version 03 is a simple two-step intake form for new dental patients. Users can fill out this form online from their own smart phone; a home computer; or in the clinic on a clinic tablet. The form requests patient information and also acts as a basic healthcare questionnaire. It includes OHIHP (The Ontario Health Insurance Plan) numbers and RAMQ (Régie de l’assurance maladie du Québec – administers the Québec Health Insurance Plan. Although this field is centric to Ontario and Quebec Canada the this form and other forms can be customized at request for other areas.

Similar Forms

dent-c19-02

COVID-19 Dental Screening & Consent

View

ortho-intake-01

Orthodontic New Patient Intake – Child

View

nat-intake-02

Naturopathic New Patient Intake – Adult

View

dent-intake-05

New Dental Patient Intake

View

dent-c19-es

Formulario del paciente para la detección de Covid-19

View

dent-intake-02

New Dental Patient Intake

View

dl-intake-01

New Patient Intake Form

View

ch-intake-02

New Patient Intake – Pediatric

View

Create an Account

Register for a free 30-day account to receive full access to ClinicForms and start saving time, while helping keep your patients and staff safe.