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Please enable JavaScript in your browser to complete this form.
Book an Appointment
Treehouse Location
*
Choose a Location
Toronto (1560 Yonge St #218)
Etobicoke (115 Humber College Blvd)
Thornhill (1 Promenade Circle, Suite 301K)
Your Information
First Name
*
Last Name
*
Street Address Line 1
*
Street Address Line 2
City
*
Province
*
Postal Code
*
Email
*
Home Phone
*
Mobile Phone
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Patient Information
Patient Name
*
Patient Age
*
Patient Gender
*
Male
Female
Patient Status
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Existing Patient
New Patient
Appointment Information
Reason for Appointment
*
Exam, Cleaning
Emergency
Recommended Treatment
Orthodontics
Other
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