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    • Examination
      • Your First Visit
      • Soft Tissue Screening
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      • General Health & Its Dental Impact
    • Hygiene
      • Brushing & Flossing Techniques
      • Dental Routine Hygiene Visit
    • Restorative
      • Fillings
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      • Endodontics (Root Canals)
      • Veneers
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      • Bridges
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      • Implants
    • Dentistry for Children-Part 1
      • Tooth Eruption Chart
      • Orthodontics
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      • Sippy Cups
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    • Dentistry for Children-Part 2
      • Pacifiers and Thumb Sucking
      • Mouth Guards
      • Preventing Cavities
      • Fluoride
      • Baby Bottle Tooth Decay
    • Surgery
      • Extraction
      • Wisdom Teeth Extraction
      • Sedation for Wisdom Teeth Removal
      • Post-Extraction Care
    • Other Information
      • Dental Forms
      • Dental Emergencies
  • FAQs
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  • Useless Knowledge
    • Useless Knowledge 2014
    • Useless Knowledge 2015
    • Useless Knowledge 2016
  • Contact Us

Call us today! (519) 756-3300

315 Brant. Ave., Brantford, ON
yourdentist@rogers.com
Langwinska Dentistry Langwinska Dentistry
  • Home
  • The Office
    • About Us
    • Meet the Team
  • Services
    • Examination
      • Your First Visit
      • Soft Tissue Screening
      • Hard Tissue Screening
      • General Health & Its Dental Impact
    • Hygiene
      • Brushing & Flossing Techniques
      • Dental Routine Hygiene Visit
    • Restorative
      • Fillings
      • Crowns
      • Bridges
      • Endodontics (Root Canals)
      • Veneers
    • Tooth Replacement
      • Bridges
      • Dentures
      • Implants
    • Dentistry for Children-Part 1
      • Tooth Eruption Chart
      • Orthodontics
      • Child Cooperation
      • Sippy Cups
      • Dental Sealants
    • Dentistry for Children-Part 2
      • Pacifiers and Thumb Sucking
      • Mouth Guards
      • Preventing Cavities
      • Fluoride
      • Baby Bottle Tooth Decay
    • Surgery
      • Extraction
      • Wisdom Teeth Extraction
      • Sedation for Wisdom Teeth Removal
      • Post-Extraction Care
    • Other Information
      • Dental Forms
      • Dental Emergencies
  • FAQs
  • Latest News
  • Useless Knowledge
    • Useless Knowledge 2014
    • Useless Knowledge 2015
    • Useless Knowledge 2016
  • Contact Us

Dental Forms


Forms we provide during your visits

Home Dental Forms

These forms use PDF format created using Adobe Reader. If you do not have Adobe Reader, please   Get Adobe Reader

The following forms are what we provide to you during particular appointments. Feel free to open and download any and all forms to access more information about what we provide at the office.

Patient Information Form

You can print this form and fill it out before attending your first dental appointment to make your initial visit a more streamlined process!

You may bring this form completed and signed to the office to streamline your initial visit.

Patient Information Consent Form

In order to provide the best quality dental care, we require your medical records along with select pieces of your personal information.

You may bring this form signed to the office to streamline your initial visit. 

Patient Information Access Form

Your privacy is of the utmost importance to us. We never disclose your information to anyone, unless we are referring you to a specialist or are required to under Canadian Provincial or Federal law.

Wisdom Teeth Extraction Consent Form

This form contains important information regarding your wisdom teeth extraction appointment at our dental office. It includes instructions on dietary restrictions before your appointment, along with sedation instructions (if applicable). It also includes information about rare, but possible, complications with your extraction appointment. This form is required to be signed before the appointment can be performed.

You may bring this form signed to the office to streamline your initial visit. 

Wisdom Teeth Post-Extraction Form

This forms contains information regarding the healing process after your wisdom teeth extraction. We provide suggested foods, along with what you should avoid to provide a quick recovery.

Contact Us

Send us an email with any inquiries you may have and we will make sure to get back to you ASAP.

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Contact Info

  • Dr. Langwinska Family Dentistry
  • 315 Brant. Ave., Brantford, ON, N3T 3J8
  • (519) 756-3300
  • yourdentist@rogers.com
  • yourfamilydental.ca

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Latest Office News

  • 2019 Holiday Schedule Here is our Holiday schedule for Christmas/New Year 2019 December...
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  • New Paintings We at Dr. Langwinska Family Dentistry are pleased to announce...
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  • Home
  • The Office
  • Services
  • FAQs
  • Latest News
  • Useless Knowledge
  • Contact Us