Patient Details
New to Dawson?*
  • Yes
  • No
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How Did You Hear About Dawson?
  • Internet / Website
  • Social Media
  • Signage
  • Radio
  • Television
  • Referral (Friends, Family)
  • Promotion
  • Student Care Network
  • Sponsorship / Event
  • Government / Healthcare Unit
  • Other Dawson
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May We Contact You By Phone*
  • Yes
  • No
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Type of Treatment*
  • Complete Oral Exam
  • Dental Cleaning & Checkup
  • Invisalign
  • Whitening
  • Veneers
  • Dental Implants
  • Broken or Chipped Tooth
  • Pain
  • Extractions
  • Other
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Location*
  • Aurora
  • Barrie
  • Brampton (Wexford Sq.)
  • Brooklin
  • Callander Bay
  • Cambridge
  • Guelph (Gordon St.)
  • Guelph (Dawson Road)
  • Hanover
  • Innisfil
  • Keswick (Cedarwood Dental, Arlington Dr.)
  • Keswick (Woodbine Ave)
  • King City
  • Kingston (Carmil Blvd)
  • Kingston (Queen St)
  • Kingston (Princess St)
  • Kitchener
  • Lucknow
  • Newmarket
  • North Bay
  • Oshawa
  • Scarborough
  • Toronto (Downtown - Queen St.)
  • Toronto (Portrait Dental - East Liberty)
  • Toronto (East York / Broadview)
  • Toronto (Rosedale)
  • Toronto (Midtown - Delisle)
  • Toronto (Yorkville)
  • Waterloo
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