Patient Forms

Thank you for choosing our clinic for your child’s dental needs! Please find the Small Smiles patient forms below for your convenience, including the patient information form, patient consent form, pre-op form, and our office policies form. If you require any further information regarding the forms, or have general questions or concerns, please feel free to contact our office during our operating hours. We can be reached at 780-758-1163 or email info@smallsmiles.ca.

For referrals, please visit our patient referrals page.

Patient Information Form

Our patient information form is to be filled out by all patients to gather basic information before any appointments or procedures with our dentists. Our goal at Small Smiles is to provide your child with the best care possible, and this will help to establish their medical/dental history and other necessary information for us to best move forward with their care at our clinic.

Personal Information Consent

Our staff are committed to the secure and responsible use of any patient information. The Personal Information Consent form outlines why information is collected and the circumstances it is used. We only ever use patient’s personal information once the consent form has been signed.

Pre-Op Form

This form is to be completed by a physician or walk-in clinic prior to your child’s operative procedure.