Appointment — Westlock Dentist

Please use the following form to submit a request for an appointment. After receiving your request, we will contact you to confirm a date that works with your availability.

Name

First Name

Last Name

Email Address

Service Requested:

Date

Preferred Date:

MM

DD

YYYY

Preferred Time

Note: We are open Monday to Thursday 9am to 5pm and Fridays 9am to 3pm.

Patient Forms

To expedite your registration process, please click the following download our patient medical history form. Please bring a printed copy of the completed form to our clinic upon the date of your appointment. Due to security reasons, we will not accept any forms submitted by email at this time. Thank you.

New Patient Form