905-822-8880 | 800 Southdown Rd. Unit A3. Mississauga, ON. L5J-2Y4 (Near the entrance to LakeShore Convention Centre)

New Patient Information

When you have a dental emergency you don't want to wait to get it fixed. We treat emergencies all the time and it is our goal to get you in the day you call. If you have a dental emergency, give us a call today and we will do our best to fit you in.

Emergency Dental Care Tips:

woman with dental Emergency

Toothache:

  1. Do not use ASA on the tooth or gums, this can cause damage.
  2. If there is swelling apply ice or cold compress.
  3. Make sure to clean around the tooth usiung salt water as a rinse.
  4. Floss if necessary to remove any particles of food that may be caught between the teeth.
  5. See a dentist as soon as possible.

Cut or Bitten Tongue, Lip or Cheek:

  1. Apply gentle but firm pressure if the area is bleeding and ice if there is swelling.
  2. If bleeding does not stop after 15 minutes go to an emergency room or urgent care centre.

Knocked Out Permanent Tooth:

  1. Find the tooth.
  2. Handle the tooth by the top (crown), not the root portion.
  3. You may rinse the tooth, but do not clean or handle the tooth unnecessarily.
  4. Try to reinsert it in its socket.
  5. Hold the tooth in place by biting on a clean gauze or cloth.
  6. If you cannot reinsert the tooth, transport the tooth in a cup containing milk or water.
  7. See a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.

Broken Braces and Wires:

  1. If a broken appliance can be removed easily, take it out.
  2. If it cannot, cover the sharp or protruding portion with cotton balls, gauze or chewing gum.
  3. a wire is stuck in the gums, cheek or tongue, DO NOT remove it.
  4. Go to a dentist immediately. Loose or broken appliances which do not bother you don’t usually require emergency attention.

Possible Broken Jaw:

  1. If a fractured jaw is suspected, try to keep the jaws from moving by using a towel, tie or handkerchief.
  2. Go to the nearest hospital emergency room.

Broken Tooth:

  1. Rinse dirt from the injured area with warm water.
  2. Place cold compresses over the face in the area of the injury.
  3. Locate and save any broken tooth fragments.
  4. Immediate dental attention is necessary.

Bleeding After Baby Tooth Falls Out:

  1. Fold and pack a clean gauze over the bleeding area.
  2. Have the child bite on the gauze with pressure for 15 minutes. This may be repeated once.
  3. If bleeding persists, see a dentist.

Dental Treatment Financing

Our team at Dentistry at Clarkson Village Shoppes believes that every patient should be able to afford the dental services they need. We help you find ways to finance your treatments with ease.

 

Payment Options

For your convenience, we accept various payment methods. You can choose to pay via cash, cheque, debit, or credit. We accept all major credit cards, including Visa, MasterCard and Discover. We also accept debit cards.

Dental financing mississauga

Ask About Low Monthly Payment Plans

Dental Card Financing Plans

Use your Dental Card Financing plan to cover any health care related expenses up to $25,000.

With Dental Card financing, your healthcare expenses come with no interest and in low monthly payments. You no longer need to settle annual fees, setup costs, or even prepayment penalties. You can also spread your payment from 3 to 60 months.

Learn how you can manage your cosmetic dentistry costs with Dental Card. Contact us today for more information.

Flexible Spending Accounts

Ask your employer if they're offering a medical spending account. With medical spending accounts, pre-tax income that is set aside for medical expenses is used to cover the cost of your cosmetic dental treatments.

Insurance Coverage

Please let us know if you have existing health insurance. We can help you check with your insurance provider if your policy covers the cost of your dental treatment. We can also assist you in filing claims.

Talk to Us Today About Your Dental Financing Options

Don't let dental costs hold you back from seeing a dental professional in Mississauga.

We'll help you look for affordable financing options so you can cover the cost of your cosmetic dental treatments. Let's see how you can extend your payment plan and lower your monthly expenses.

Please call us at 905-822-8880 to discuss more about financing plans available to you.


New Patient Forms

Please fill in the form to submit it electronically to our office. If you would rather fill out a printable version of the form you can download it by clicking the button below.

If you have additional dental care related concerns, please feel free to contact our team at 905-822-8880. We’ll do our best to respond to your questions. We’re excited to see you in our practice. For the meantime, you may refer to these pages for more information on dental services we provide.

To get a glimpse of the changes you are likely to achieve after getting dental services, visit our Before and After page. A better lifestyle starts with a healthy smile. We’re here to help.

Your Name*

Date of birth

Email Address*

Phone Numbers

Your Address*

How did you hear about our office (Friend, Family, mail, sign, websearch, Facebook, etc)?


Do you have Dental Insurance?*

Yes
No

If yes, please fill in the following insurance information. Otherwise, skip this section


Primary Insurance Company

Company Name

Policy Number

Sub. ID

Policy Holder's Name

Policy Holder's Date of birth

Policy Holder's Employer


Secondary Insurance Company (if applicable)


Company Name

Policy Number

Sub. ID

Policy Holder's Name

Policy Holder's Date of birth

Policy Holder's Employer


Family Doctor's Name

Have you ever had a serious injury or major operation?*

If yes, what and when?

Are you in good health now?*

Are you presently being treated by a physician?*

Are you taking any medications, pills, drugs, or medicine?*

(if yes please list)

Allergies: Have you ever had a reaction to any of the following?*

Penicillin
Local Anesthetic (Freezing)
General Anesthetic
Codeine
Asprin
No Drug Allergies
other (please specifiy below)

Do you have or have you had any of the following conditions. Please check all that apply:*

Heart trouble or stroke
Bleeding problem or blood disorder
Kidney Disease
Hepatitis
Liver Disease
Jaundice
High or low blood pressure
Jaundice
Nervous
Chest pains
Shortness of breath, asthma or allergies
Tuberculosis
Epilepsy or seizures
Cancer of any kind
Stomach Disorders/Ulcers
Diabetes
Frequent Headaches
Rheumatic Fever
Arthritis
Infectious Disease
Immune Disorder
You currently suffer from a prolonged cough
You currently have an undiagnosed skin rash
You suffer from diarrhea
None of the above

Are you pregnant?*

If 'yes' please provide your due date:

Is there anything else we should know about your health?


Is there a dental problem you would like treated immediately? If yes, please explain.*

Are there any other dental condition that concern you at present? If yes, please explain *

Are there any dental issues that you want addressed in the future? If yes, please explain.*

How frequently do you see your dentist? *

Date of your last dental visit?

Date of your last dental cleaning?

Date of your last x-rays?

Do you have or have you had any of the following conditions. Please check all that apply:*

Periodontal Treatment (treatment of the gums)
Orthodontics Treatment (to straighten or realign teeth)
A bite plate, night guard or other appliance
Dentures or partial dentures
Wisdom teeth removed
Root canal treatment
Crown or bridge
None of the above

Are there any growths or sore spots in your mouth? *

Do your gums bleed when brushing or eating, or do you suffer from pain or swelling of your gums? *

Have you been given oral hygiene instruction in brushing, flossing or other instructions? *

Have you noticed any loose teeth, or, have any of your teeth shifted? *

Does food catch between your teeth? *

Are any of your teeth sensitive to heat, cold, sweets or pressure? *

Have you ever experienced any of the following jaw problems: Please check all that apply: *

Popping/clicking in your jaw joints.
Pain in your jaw joints, around your ear or side of your face.
Difficulty opening or closing.
Pain when teeth are clenched.
Pain or difficulty while chewing.
None of the above

Do you have any of the following habits? Please check all that apply. *

Clenching or grinding your teeth while awake or asleep?
Biting your cheeks or lips?
Mouth breathing while awake or asleep?
Gag reflex?
None of the above.

Are you missing any teeth? If so, have they been replaced? If not would you like them replaced? *

Are you dissatisfied with the appearance of your teeth? *

What would you like to see improved if anything? *

Are you interested in discuss any of the following with the dentist or hygienist? *

Teeth whitening or bleaching
Cosmetic dentistry
Orthodontic treatment
None of the above

Have you ever had local anesthetics (freezing)? If yes did you have any problems? *

Have you ever had an upsetting experience in a dental office, or any complications during or following dental treatment, or, do you have any questions or concerns? *

Privacy Statement

I agree with the privacy policies as described
© Dentistry at Clarkson Village Shoppes
SEO & Dental Marketing by UpOnline.
UpOnline for Dentistry at Clarkson Village Shoppes