Please ensure Javascript is enabled for purposes of website accessibility

New Patients Are Welcome!

SCHEDULE AN APPOINTMENT
(403) 337-2332
MENU
ONLINE SCHEDULING
Home » New Patient Form Child

New Patient Form Child

  • MM slash DD slash YYYY

  • Patient Medical History

  • Patient Dental History

  • Upload a Photo

  • Max. file size: 500 MB.
  • I agree to pay value of said services,which shall be as billed unless objected to by me, in writing, within the time for payment thereof. I agree that a waiver of any breach of any time or condition hereunder shall not constitute a waiver of any further term or condition and I further agree to pay all costs and reasonable attorney fees if suit be instituted hereunder. I understand my personal information disclosed is protected by the Privacy Act. I agree that Carstairs Dental can electronically file dental claims on my behalf. In compliance with Canadian Anti-Spam Laws, you understand that by clicking submit, you give us permission to send you information on products and services and information such as news and events.
  • This field is for validation purposes and should be left unchanged.
Pay Bright - Dental Insurance | Carstairs Dental Clinic | Dentist in Carstairs, AB

Our Office

Address

1118 Hammond St. Carstairs,
Alberta T0M 0N0 Canada

Phone

(403) 337-2332

Email

info@carstairsdental.com

Business Hours

Monday: 10am – 6pm
Tuesday: 10am – 6pm
Wednesday: 8am – 4pm
Thursday: 8am – 4pm
Friday: 8am – 4pm
Saturday: Closed
Sunday: Closed

Smile Appearance | Carstairs Dental Clinic | Dentist in Carstairs, AB
Facebook Instagram
Schedule An Appointment
CONTACT

Carstairs Dental
Dr. Herman Nijjar
1118 Hammond St, Carstairs, AB T0M 0N0, Canada
(403) 337-2332
info@carstairsdental.com

OFFICE HOURS

Monday: 10am to 6pm
Tuesday: 10am to 6pm
Wednesday: 8am to 4pm
Thursday: 8am to 4pm
Friday: 8am to 4pm

QUICK LINKS

About
Services
Blog
Contact Us

© 2025 Carstairs Dental | All Rights Reserved.