To download each of the forms, simply click on the link.
(please note - the first two links have two pages to be completed)

​3 Ways forms can be delivered to Preferred Dental Hygiene Services…

1)Scanned/e-mailed to
2)Sent by mail to 1686 Ironwood Rd London, ON N6K 5C4
3)Call and arrange for forms to be picked up at 519-639-3437

Please Note: In order to be able to treat each patient in a safe and effective manner, we require that a Medical and Dental history is completed in addition to the New Patient Form. 
If a patient is unable to complete the forms by themselves,a family member, guardian, friend, nurse/personal support worker may help to complete the forms but a patient or their power of attorney must sign the forms prior to treatment.

Any Questions about scheduling an appointment or completing initial paperwork?
Please call Sheri McIntosh at 519-639-3437 for help/assistance