Contact Winona Dental

Interested in becoming a patient at Winona Dental? We’d love to hear from you.

How would you prefer to be contacted?
winona dental patient code
Book an Appointment

For prospective patients looking to join our dental centre, we request that you take a few moments to fill-out our new patient forms so that the dentist has your important medical and health information on hand.

We’ve made the forms available here so that you can download and fill-out the new patient forms at your convenience when you have all your important information readily available.

New Patient Form Image
Form: New Patient Form
Pages: 2 Pages
Purpose: Required to ensure we have your contact, medical contact and insurance information on record.
Required: Yes

Medical Dental History Form Image
Form: Medical & Dental History
Pages: 3 Pages
Purpose: Required to ensure the dentist is aware of your dental care habits, any medication being taken and if there are any preexisting health conditions.
Required: Yes
Patient Disclosure Consent Form Image
Form: Disclosure Consent Form
Pages: 3 Pages
Purpose: Patient acknowledgement consenting to how we collect and use your health information.
Required: Yes
Consent form for the release of your previous Diagnostic Radiographs and/or Dental Records from Previous Dental Office
Form: Consent Form for the Release of Your Diagnostic Radiographs and/or Previous Dental Records from your Previous Dentist
Pages: 1 Page
Purpose: Authorize the release and transfer or your prior dental records from your previous dentist
Required: No
Patient Covid-19 Questionnaire
Form: COVID-19 Screening Form
Pages: 1 Page
Purpose: Patient screening questions for COVID-19
Required: Yes
For more information on booking a dental appointment.
Please refer to our patient resources or feel free to contact us.