Please provide us with your appointment preferences.
It would be wonderful if you could please complete our appointment preference form, and we will arrange for a suitable time for you. Due to the extremely high volume of patients that require new appointments, please utilize our survey instead of phoning us. Thank you! (We will be attempting to book you in the order you were initially booked).  
For our Observation or retainer check patients - we are happy to see you anytime virtually! Please visit our website at www.clearlyortho.com and click on the Virtual Consultation link.
Sign in to Google to save your progress. Learn more
Patient Full Name *
What days of the week are best for you? Please check all days that work for you. *
Required
What time of day is best for you? Please check all times that work for you. *
Required
How should we notify you of your new appointment date and time? *
Required
Please provide your mobile phone number OR email for your appointment notification. *
Do you have any broken braces?
Clear selection
We will do our best to provide you with your appointment date and time as soon as we can! If you require a change, we ask that you reply to your text or email.
Please remember to text us at (416) 226-5050 when you arrive, and wait outside. Only the patient will come into office to allow us to maintain physical distancing.  For our younger patients - don't worry - we will update you following the appointment as to what was done.
PLEASE WEAR A MASK to your appointment.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms