This form is required for all new patients coming to Harbour Landing Dental.  If your are a new patient, please fill out this form so we may provide the proper treatment and have access to any special requirements or conditions that you may have. 

One form is required for each person, so if you have a family of 3, you will need to fill out 3 forms.

You can access the form and type directly into it using Access Form.  Or you can download the form and print it, and then fill them out by hand.

Are you having trouble accessing the form?

Adobe Reader Version 8.1 and up contains new features that allows you to type directly into the form, and then print it.  Previous versions of Adobe Reader do not support this feature.

You will need Adobe Reader installed on your computer in order to complete the form.  If you do not have Adobe Reader Installed, you can click below to download the program direct from Adobe.