Patient Forms

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Patient Forms

Please fill out our secure HIPAA compliant forms online, or print them at home and fill them out prior to your first visit.
If you require assistance, please call 250-751-8782

New Patient Information Form

Patient Medical History Form

Book an Appointment Today

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form online

Brickyard Dental Clinic
201- 6010 Brickyard Rd
Nanaimo, BC V9V 1S5

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