Patient Symptom Form

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

If no please go to question 11.

Please fill the frequency and quality of the discomfort, with the number that most closely reflects the intensity of your pain:

LEVEL OF INTENSITY: Scale of 1-10. 1= MILD 10= SERVERE

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.

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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

Address:
102-1500 Bank street Ottawa, Ontario K1H 7Z2
613-706-4101
Info@blueherondentalgroup.ca