New Patient Form

Kids Dentistry

If your child has an appointment to see one of our pediatric dentists, please complete and submit this form. 

Patient Information

Health History

Please indicate if your child has any history of the following conditions.

Parent / Guardian Information

Insurance Information

Primary Dental Insurance
Secondary Dental Insurance

Consent for Treatment / Office Policies

New Patients Always Welcome

We're always happy to welcome new patients to our Richmond Hill dental practice, with or without a referral. 

Request Appointment


Richmond Hill Kids Dentistry and Orthodontics
10 Headdon Gate unit 1A, Richmond Hill, ON L4C 8A2 CA

Phone Number

(905) 224-7916


  • Monday: 09:00 am - 06:00 pm
  • Tuesday: 08:00 am - 06:00 pm
  • Wednesday: 08:00 am - 05:00 pm
  • Thursday: 08:00 am - 05:00 pm
  • Friday: 08:00 am - 02:00 pm
  • Saturday: Closed
  • Sunday: Closed

(905) 224-7916