Appointment

840-2025 Willingdon Ave Burnaby BC V5C 0J3

Complimentary underground parking available. Please follow Office visitor parking “LO” level.

Phone: 604-299-1661
Fax: 604-299-1671
Email

Schedule an Appointment

Please contact our office by phone or complete the appointment request form below.
Our scheduling coordinator will contact you to confirm your appointment.

SELF REFERRAL
DOCTOR REFERRAL

Reason for your appointment*:

First Name*

Last Name*

Address*

Postal Code

Business Phone

Cell Phone*

Email*

Preferred Date*

Preferred Time*

Attach Files

Comment or Message*

By filling this form out, it does not guarantee an appointment, the office will contact them in 1 to 2 business days to provide appointment date and time. If this is an emergency, please call our office.

Download PDF

Please enter the teeth affected:
Date*
Introducing*
Patient Phone* Appointment*
Doctor's Email*
Referring Office* Phone*


Please Check
Consultation Only Endodontic Treatment Core Build Up Post Space Place Post Close with Temporary Close with Permanent Sedation Required
Remarks
Doctor Signed*
Insurance Coverage
Primary Coverage
Carrier Subscriber
DOB Plan #
ID #
Secondary Coverage
Carrier Subscriber
DOB Plan #
ID #
Please provide us with a minimum of two business days notice to change or cancel an appointment in order to avoid any cancellation charges.

840-2025 Willingdon Ave
Burnaby, BC V5C 0J3

Get Directions

Phone: 604-299-1661
Fax: 604-299-1671

Appointment

Schedule an Appointment

Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please contact our office by phone or complete the appointment request form below.
Our scheduling coordinator will contact you to confirm your appointment.