This form is intended exclusively for new patients seeking an initial orthodontic consultation. Please note that we do not provide care for retention appliances (lingual wire or retainer trays) when the initial treatment was not completed at our clinic. If you were treated at our clinic, we invite you to contact our team directly by phone at (450) 378-2365.

Please note that we are not registered with the Canadian Dental Care Plan.

I certify that the information provided is accurate. I have been informed that if the patient’s primary residence is not located in the Granby region over the next two years, it is highly likely that no orthodontic treatment can be initiated and that consultation fees will remain payable.