Are you accepting new patients?

Yes. Prince Albert Dental Clinic welcomes new patients of all ages, including emergency walk-ins and same-day appointments. New patient forms can be completed online before your first visit.

What should I do if I have a dental emergency?

Call us right away at (306) 764-5374. We keep room for same-day emergency appointments and accept walk-ins for problems like severe toothache, swelling, a knocked-out or fractured tooth, or a lost filling or crown.

Do you accept the CDCP and bill insurance directly?

Both. We support patients who qualify for Canadian Dental Care Plan benefits, and we bill most insurance providers directly so there is less paperwork and less to pay on the day. Financing is available for larger treatment plans.

I find dental treatment difficult. Can you help?

Tell us before we start. We offer sedation options for patients with dental anxiety, and we work at your pace — explaining each step before it happens and stopping whenever you ask.

Do you treat children?

Yes. Children's dentistry is part of what we do every day, including sealants and fluoride, space maintainers and gentle first visits, alongside family dental care for the rest of the household.

When are you open, and how do I book?

The clinic is open Monday to Saturday, 8:00 am to 5:00 pm, and closed on Sunday. Call (306) 764-5374 or use the online booking form to arrange a visit.

New Patient Form | Prince Albert Dental Clinic

Full name

Email

Phone

Birth date

Sex

MaleFemaleOther

Status

Emergency contact

Emergency contact phone

Whom may we thank for your referral?

Have you been under the care of a medical doctor during the past two years?

YesNo

Are you aware of having an allergic (or adverse) reaction to any medication or substance?

YesNo

Indicate which of the following you have had, or presently have (optional — check all that apply)

Do you have, or have you had, any medical conditions not listed?

YesNo

If yes, please describe

Women (optional)

Are you pregnant?

YesNo

Are you nursing?

YesNo

Are you taking birth control?

YesNo

What can we do to make YOU smile? Check all that apply.

Are you apprehensive about dental treatment?

YesNo

Do you have previous dental crowns?

YesNo

Have you had problems with previous dental treatment?

YesNo

Does the saliva in your mouth seem too much?

YesNo

Do you gag easily?

YesNo

Have you had orthodontic (braces) treatment?

YesNo

Do you wear dentures?

YesNo

Does food catch between your teeth?

YesNo

Have you ever noticed a slow-healing sore in your mouth?

YesNo

Do you have difficulty chewing your food?

YesNo

Do you experience pain when you chew?

YesNo

Do you avoid brushing any part of your mouth because of pain?

YesNo

Do you have temporomandibular jaw disorder (TMD)?

YesNo

Are your teeth sensitive to cold?

YesNo

Do you clench or grind your teeth frequently?

YesNo

Are your teeth sensitive to heat?

YesNo

Are you satisfied with the appearance of your teeth?

YesNo

Are your teeth sensitive to sweets?

YesNo

Do you experience headaches or migraines?

YesNo

Are your teeth sensitive to sours?

YesNo

Do you notice an unpleasant taste or odour in your mouth?

YesNo

Do your gums bleed when you brush or floss?

YesNo

Do you have sleep problems?

YesNo

Do you have previous dental implants?

YesNo

Treatment consent

I, the undersigned, authorize Prince Albert Dental Clinic to perform any necessary dental services and oral surgery that I may need during my diagnosis and treatment with my informed consent. I certify that the medical and dental histories provided are accurate and complete to the best of my knowledge. I also understand that any and all dental services are my sole responsibility and that I should make myself aware of any fees associated with my dental care prior to treatment. I also acknowledge that there is no expressed or implied guarantee of any procedure or dental treatment provided.

I have read and agree to the treatment consent above.

Signature — type your full name

New Patient Form

Patient informationStep 1 of 3: Patient information

Treatment consent