1192 Melville St, Vancouver, BC V6E 4P6
604-336-2130
Request Appointment
Text Us For Your Appointment : 604-907(3368)
info@vancouverharbourdental.com
(604)336-2130
Accepting New Patients
About us
Dental Services
Dental Cleanings and Exams
Cosmetic Injectables
Complete & Partial Dentures
Cosmetic Dentistry
Dental Crowns & Bridges
Dental Implants
Night Guards & Sports Guards
Teeth Whitening
Root Canal Therapy
Wisdom Tooth Removal
Invisalign Treatment
Contact Us
Home
Accepting New Patients
New Patients Registration Form
"
*
" indicates required fields
Your Name
*
Phone Number
*
Email Address
Are you an Existing patient?
*
Yes
No
Best Time For Appointment
*
Morning
Afternoon
Evening
I'm flexible
Preferred Day Of The Week
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Purpose of appointment / Type of treatment
*
Please Select
New Patient Exam
Hygiene / Check-up
Dental Emergency
Invisalign Consultation
Implant Consultation
Cosmetic Consultation
Other
Comments or Questions
Is there anything else you’d like us to know?
Comments
This field is for validation purposes and should be left unchanged.
Δ
All Rights Reserved © 2023. Designed by
Vantechs
All Rights Reserved © 2023. Designed by
Vantechs
Please ensure Javascript is enabled for purposes of
website accessibility
