This form is to be completed by both current and new adult (18 years +) patients of our practice. It will allow us to update your contact information, medical history, and understand any dental concerns you may have.
It can be completed online and printed for you to bring to your appointment. You can also complete it online and then email it to us at drhennessy@ns.aliantzinc.ca.
This form will be updated annually in our office. You do not need to complete a new one each year.
It can be completed online and printed for you to bring to your appointment. You can also complete it online and then email it to us at drhennessy@ns.aliantzinc.ca.
This form will be updated annually in our office. You do not need to complete a new one each year.
This form is to be completed by the parent/guardian of dependent children. It allows us to have important information about your child's previous dental experiences, as well as information about their medical history.
If you are living independently (regardless of age) please complete the adult form above.
It can be completed online and printed for you to bring to your child's first appointment. You can also complete it online and then email it to us at drhennessy@ns.aliantzinc.ca.
If you are living independently (regardless of age) please complete the adult form above.
It can be completed online and printed for you to bring to your child's first appointment. You can also complete it online and then email it to us at drhennessy@ns.aliantzinc.ca.
This form is used when you would like us to make a request to your previous dental office to have your/ your family's records
(chart notes and any x'rays) sent to us. This is helpful as it gives us a history of when you were last seen, what work was done elsewhere, as well as a chance to look at your previous radiographs.
Like our other forms, you can complete it online and email it to us at drhennessy@ns.aliantzinc.ca or print it and bring it to your appointment.
We are not legally permitted to request your documents without this completed form.
(chart notes and any x'rays) sent to us. This is helpful as it gives us a history of when you were last seen, what work was done elsewhere, as well as a chance to look at your previous radiographs.
Like our other forms, you can complete it online and email it to us at drhennessy@ns.aliantzinc.ca or print it and bring it to your appointment.
We are not legally permitted to request your documents without this completed form.