Dental Patient Pre-Assessment & Treatment Request

Dental Patient Pre-Assessment & Treatment Request

1. Personal Information

2. Main Reason for Dental Treatment

3. Requested Treatment (If Known)

4. Current Dental Condition

5. Previous Dental History

6. Medical Information (Important for Doctors)

7. Patient Expectations

8. Timeline & Travel Planning

4. Upload Section (VERY IMPORTANT)

Carenfly.com

Carenfly Inc. is a federally incorporated company in Canada. Corporation Number: 1724247-6  Registered Office: Toronto, Ontario, Canada

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