Oceanside Dental ~ Creating Beautiful Smiles
Cosmetic, Laser & General Dentistry on Vancouver Island, Campbell River, British Columbia.
Home
Contact Us
Make An Appointment
New Patient Info Form
e-News
About Us
Meet Our Doctor
Meet Our Smile Team
Community Commitment
About Our Dentistry
Metal / Mercury Free Dentistry
Dental Wellness
Professional Preventative Cleaning
TMD/TMJ Relief
Full Mouth Rejuvenation
Frequently Asked Questions
Laser Dentistry
No Needle, No Drill
Deep Laser Whitening
Laser Periodontal Therapy
Cosmetic Dentistry
Smile Makeovers
The LVI Smile
Deep Laser Whitening
View our smile gallery
e
Smile News
For news and information on dental health, advancements and tips to keep you smiling, sign-up for our FREE eSmile News newsletter.
Contact Us -
Make an Appointment
*
Your Name:
Reason for your visit:
(check more than one if you wish)
New Patient Examination
Smile Consultation
Periodontal Wellness / Cleaning
General Treatment
Metal / Mercury Filling Replacement
TMD / TMJ Relief
Deep Laser Whitening
*
Email:
*
Day Phone:
-
Evening Phone:
-
Best time to
contact you:
Day ph#:
Evening ph#:
Mailing Address:
How did you hear of us?:
Do you have dental insurance?:
yes
no
How do you perceive
your dental health?:
On a scale of 1-10 (10 being best)
Additional comments, questions or feed back for us?
*
Asterisk indicates a compulsory field.
*
*
Please fill in these fields before submitting
*
Click
to send this form.
Click
to clear your message and start over.