• Patient Screening Form

    Fairway Dental Clinic

    385 Fairway Road South, Unit #203
    Kitchener, Ontario, Canada N2C 2N9
    Phone: 519-893-9494

  • Date Format: DD slash MM slash YYYY
  • Date Format: DD slash MM slash YYYY
  • :
  • Screening Questions Pre-Screen

  • Date Format: DD slash MM slash YYYY