Centre Dentaire La Couronne
Centre DentaireLa Couronne
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Centre Dentaire La Couronne
Centre DentaireLa Couronne
6B, Boulevard Cartier Ouest,Laval, QC H7G 2S7
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Centre Dentaire La Couronne

Centre Dentaire La Couronne

Phone+1 (450) 238-0308

Emailinfo@lacouronnedentaire.ca

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Confidential and Secure Health Questionnaire

The dental file is created as part of the care provided. It is protected by law and professional confidentiality. It is kept securely at the clinic, and only the dentist and authorized clinic staff have access to it. Patients may contact the clinic to request access to their file or to correct inaccurate information.

Fields marked with an asterisk (*) are required.

Patient Information
Gender
Are you a beneficiary of a social assistance program in Quebec?
Are you covered by the Canadian Dental Care Plan (CDCP)?*
Address

Enter the 10 digits only.

Date of Birth
Health Insurance
Minor Patient
Referral