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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Contact Us

102-1500 Bank street Ottawa, Ontario K1H 7Z2

613-706-4101

Info@blueherondentalgroup.ca

 

Clinic Hours

Mon:             7:30am - 3:30pm
Tue:               7:30am - 3:30pm
Wed:             7:30am - 3:30pm
Thu:               7:30am - 7:30pm
Fri:                 7:30am - 3:00pm

Sat:                         Closed
Sun:                        Closed

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