Appointment Inquiry

Appointment Inquiry

Code: LISAWEI
Please choose your preferred gift:*

Lululemon Gift Card ($100)ZARA Gift Card ($100)Alo Gift Card ($100)Sephora Gift Card ($100)Apple Gift Card ($100)Hammam Spa Gift Card ($100)
*HealthX Canada will send you your $100 gift card upon completion of your new patient exam and cleaning at one of our partner locations. Conditions apply!
Please choose your preferred location(s):*

Bite Dental (106 Mutual St, Toronto)Yonge & Front Dental (26 Wellington St E, Toronto)Westdale Dentistry (875 Main St W, Hamilton)Dentistry by The Bay (220 Dundas St E, Belleville)Clearview Dental (427 Dundas St W, Trenton)Katbab Dentistry (7163 Yonge St, Thornhil)
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Preferred Appointment Date*
Reason for your appointment/visit:

New Patient Exam and CleaningTeeth WhiteningDental Implants Free ConsultationBotox for TMJ PainINVISALIGNVeneersRoot CanalOther
Notes for the dentist/hygienist:
Should be Empty: