Patient information

First visit form

Fill it out online in a few minutes, or at home and bring it to your appointment: you'll spend less time in the waiting room. Your information is kept strictly confidential.

A baby laughs on the sofa in the clinic's lounge, dental loupes around their neck

Two options

Fill out your form online, or download it and bring it to your appointment.

All patient information

Option 1 · the easiestFill out onlineQuestionnaire, consent and appointment request in a single submission, in about five minutes.Start Option 2Download and fill outFill them out on screen or print them, then bring the forms to your appointment.See the forms

First visit formPDF · fill out on screen or print · 760 KBOnline Download
Consent form · adultPDF · fill out on screen and sign · 14 KBOnline Download

Plan your next visit

Address: 1300, chemin des Patriotes, Richelieu (QC) J3L 4S6
Get directionsOn-site parking
Wheelchair access
Phone: 450 447-7776
Email: info@centredentairerichelieu.com
Hours: Mon9 am – 8:30 pm
Tue8:30 am – 8:30 pm
Wed8 am – 8:30 pm
Thu8:30 am – 4 pm
Fri8:30 am – 4 pm
SatClosed
SunClosed
Emergency? Call us at 450 447-7776

Appointment request

A few quick questions, then pick your time slot.

Request an appointment

First visit form

Plan your next visitPlanyournextvisit

Appointment request

Plan your next visit