Health Form

Personal Information

Gender

Contact Information

Emergency Contact

Dental Information

Last visit: *
Are you uncomfortable with dental treatments? *
With panoramic dental x-ray (large x-ray)? *
With intraoral dental x-rays (small x-rays)? *

Financing

Take care of your smile with peace of mind. Clinique Dentaire Oliveira offers flexible financing options to make your care accessible.

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