Patient Registration Form

Please complete the form below; for best results use Google Chrome or Mozilla Firefox browsers.

Please include city and post code.
Please provide all numbers that are available - Home, Work, Cell. As well as Spouse Cell + Work.
I consent to be contacted by Email if I have provided my Email address to the office.
Name + Phone Number
(Name + Relationship + Phone Number)
Name + Phone Number
Please let the front desk know if you have more than one insurance.

Dental History

Medical History

New To The Clinic ?

Blue Heron Dental Group is built on a strong reputation of over 30 years of service to the Ottawa community and the families who live here. Other dentists in the community refer pediatric patients to our clinic due to our experience and reputation when treating children.

Book An Appointment

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Let's Start a Conversation

Clinic HOURS:
Monday 7:30-4:00pm
Tuesday 7:30-4:00pm
Wednesday 7:30-4:00pm
Thursday 7:30-8:00pm
Friday 7:30-3:30pm

102-1500 Bank street Ottawa, Ontario K1H 7Z2