Brockville
Oral Surgery

135 Ormond St Suite 101
Brockville, ON K6V 5Y2

North Bay
Oral Surgery

180 Shirreff Ave. Suite 240
North Bay, ON P1B 7K9

Downtown Toronto
Oral Surgery

790 Bay St. Suite#1014
Toronto, Ontario  M5G 1N5

Youth Teeth Charting

Adult Teeth Charting

You can upload JPEG, PNG, or PDF files. Max. size is 5MB.

If you need a copy of this form for your records, click the print button below BEFORE sending the form