Please fill out the form below to contact us about making your child’s appointment
Please complete this form, save completed NEW PATIENT FORM, and attach as indicated below.
Your Name (required)
Patients Name (required)
Your Email (required)
Telephone (required)
Preferred Day and Time for Appointment
Reason for Visit
Attach New Patient Form
Your Message
604.343.3810
contact@kidsteeth.ca
200-1060 Austin Ave. Coquitlam, BC V3K 3P3
