New or Existing Patient*
Yes
No
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May We Contact You by Phone?*
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Closest 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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Type of Treatment*
Veneers
Whitening
Invisalign
Braces
Teeth-in-a-day / All On 4
Snap on Smile
Dental Implants
Gum Contouring
Sedation
Sleep Apnea
Broken or Chipped Tooth
Extractions
TMJ
Other
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Would You Like to Book a Free Virtual Consultation*
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No
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How did You Hear About Us?
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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