Becoming a Patient is as Easy as 1,2,3

Just Choose One of the following...

1. Call (613) 332-6800 2. Email: bancroftdentalcentre@bellnet.ca 3. Visit Us In Person at 68 Hastings St. N., Bancroft ON

Patient Registration Forms

MEDICAL/DENTAL HISTORY FORM TRANSFER OF RECORDS FORM

How to Get To Us!

Directions

Bancroft Dental Centre is located at 68 Hastings St. North beside Starbucks and behind Re-Max where the former Life Labs business used to be.

The easiest way to get to our office is to enter through the Pizza Pizza driveway and proceed straight to the back of the parking lot where you will see our sign. We have a dedicated parking for our patients and you may park as close to the building as you wish.

MEDICAL/DENTAL HISTORY FORM

Please click on the button below to download the Medical History form.

Print this form and complete then bring it with you to your first appointment.

Alternatively, you can:

1. Scan the complete 2-page form and email to us

2. Take a photo of your completed form and email to us.

Important: Please ensure the the form is completed entirely, signed and dated.

Medical History form for Emailing (pdf)Download

TRANSFER of RECORDS FORM

There are 2 ways to complete this form:

Download and Print the form then email the form to bancroftdentalcentre@bellnet.ca ~ (You can simply take a photo of your signed form and email the photo)
Download and Print the form then bring it to our office BEFORE your first appointment.

Records Transfer Authorization (pdf)Download