Patient Forms
Welcome Aboard
We value the privacy & security of our patient’s data. Information entered into these forms gets sent through an encrypted, secure system that only our team can unlock!
Patient Information Form
Please fill out the easy-to-use, private, and secure intake form. It will take a few minutes to complete, but this form helps us gather essential details about your medical history and dental concerns. Our dental team reviews this in detail to provide comprehensive care.
Click Here For The Patient Information Form.
Consent To Transfer Of Records Form
With your permission we will contact your previous dentist to obtain any relevant x-rays or records.
Click Here For The Transfer Of Records Form.
Know Your Coverage
Due to current privacy laws, many insurance companies will not provide us with any information regarding your plan. To assist you best, we encourage you to take the time to contact your insurance provider and request a breakdown.
Once we have this information, we will have a better understanding of your coverage and will be happy to clarify any questions you may have. Please note the treatment options presented to you from our team are based upon our professional judgment and not based on your coverage by a dental benefit plan.
Click Here For Questions to Ask Your Dental Insurance Provider.
Consent To For CDCP Coverage
Acknowledgement that the patient has the Canadian Dental Care Plan and any difference between the fee charged by Henley Dental and the amount covered by CDCP insurance plan is the patient’s responsibility for payment.
Click Here For the CDCP Consent Form
Existing Patient Medical History Form
Please complete this straightforward, confidential, and secure form. Our dental team will carefully review your updates to ensure you continue to receive the highest quality of care. This form is for our existing patients only.