New Patient Forms

By filling out these forms ahead of time you will save significant time on your visit. If you have any questions when filling out the form, please do the best you can, and our staff will assist you with your questions on the day of your appointment.

or

Download Paper Forms (PDFs)

The following forms can be downloaded to your computer. Please complete the information and bring them with you to your first visit.

Download Paper Forms (PDFs)
Medical / Dental Records Forms
 Registration Form
 Dental Redords Release
  COVID-19 Screening
Consent Forms
 COVID-19 Pandemic Emergency Dental Risk
 Personal Information Consent
 Consent for Root Canal Treatment
 Consent for Crowns & Bridge Prosthetics
 Consent for Extraction of Teeth
 Consent for Crown Lengthening
 Consent for Gingival Grafting Surgery
 Consent for Implant Removal
 Consent for Implant Surgery
 Consent for Maxillary Sinus Elevation Surgery
 Consent for Endodontic Treatment
 Consent for Nitrous Oxide/Oxygen Sedation
 Consent for Social Media

Technical Note:
Our online forms use the Adobe Acrobat Plugin.
Please download the free plug-in from Adobe's website if it is not already installed on your system. It is important that you have the latest version, in order to open, fill and save our forms.

  Get Adobe Reader

Dr. Kutaiba Alzohaili Sana Dentistry  -  Mississauga

Meet Dr. Kutaiba Alzohaili

Dr. Kutaiba Alzohaili is very passionate about dentistry. This profession allows him to employ his excellent technical skills to help improve peoples’ lives through better health, stronger self-esteem, and wellness.

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