Dr. Johnson Dental History Questionnaire

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

In order to provide safe dental care for our patients, we are asking you to fill out the following questionnaire. Please answer the questions as accurately as you can. If you have any questions or doubts, check the not sure / maybe choice. Your responses will be reviewed with you by the dentist. You can be assured that the information you provide will be kept in the strictest confidence.
Please provide all numbers that are available - Home, Work, Cell. As well as Spouse Cell + Work.
M S W D
(Name + Relationship)
Please include city and post code.

Dental History

Patients Over 18 Years Of Age.

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 7:30-8:00pm
Tuesday 7:30-3:30pm
Wednesday 7:30-3:30pm
Thursday 7:30-8:00pm
Friday 7:30-3:30pm

We're also open one Saturday a month.
Check our Google Business for holiday hours.

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