PATIENT FORMS

Feel free to download and  fill in these forms before coming in.

MEDICAL & DENTAL HISTORY FORM

INSURANCE FORM

(For patients with Insurance coverage)

INSURANCE FORM

(For patients without Insurance coverage)

REGISTRATION FORM

These forms require Adobe Reader for full functionality. Please download the mobile version or the desktop version.

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Convenient Location in Caledonia

Dr. Kal & Farah

Caledonia Smiles services the following areas and postal codes in Ontario

Caledonia, Simcoe, Ingersoll, Dunnville, Delhi, Paris, Tillsonburg, St. Mary's and more.

N0A, N0E, N0J, N1A, N4B, N3W, N3Y, N3L, N4G, N4X

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