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  • Home
  • About
    • About our Office
    • Root Canal Specialist
    • Reviews
  • Services
    • Composite Restorations
    • Dental Bridges
    • Dental Crowns
    • Dental Extractions
    • Dentures
    • Night and Sports Guards
    • Oral Hygiene
    • Root Canal Therapy
    • Sedation Dentistry
    • Teeth Whitening
  • Patient Centre
    • Initial Visit
    • Patient Forms
      • New Patient Form
      • Medical History Update
      • 5 Years Update Form
      • Endo NP Forms
      • Covid-19 Screening Form
      • COVID-19 Pandemic Dental Risk Consent
    • Dental Emergency
    • Payment Options
    • Links
  • Referrals
    • Endodontics Referral
  • Blog
    • News
  • Service Area
    • Kitchener Ontario
      • Alpine Ontario
      • Bridgeport Ontario
      • Brigadoon Ontario
      • Centreville Ontario
      • Country Hills Ontario
      • View All Areas
  • Book an Appointment
  • New Patient Form

    Sherwood Dental

    501 Krug St #113
    Kitchener, ON N2B 1L3
    Phone: 519-576-2170

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    *Please note, patient is responsible with providing us a copy of their insurance card(s).*
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  • Do you or have you ever had an adverse reaction or allergy to:

  • Have you ever had any of the following? Please check those that apply:

  • If you had any surgeries please specify the surgery date and information.
  • Consent for Services & Office Agreement

    * I understand that my family’s appointments are valuable, and that 2 Business days must be given if we are unable to attend appointments. A missed standard appointment may incur a fee.

    *I will be required to pay for my family treatment at each visit. For treatment involving laboratory work, I will be required to place a deposit for the estimated lab work required (this is separate from Dental office fees).

    *I understand that outstanding account balances will be passed to a Credit Agency and/or to the Ontario Court System.

    *I understand there are premium times in great demand. If I am not attending these premium appointments and thus preventing other patients from making effective use of these times, I will be required to make use of regular hours for treatment.

    *My dental insurance plan is a contract between myself and the organization providing me with the coverage. It is my responsibility to ensure that the treatment I request is covered. However, Sherwood Dental will help me to the best of their abilities to ensure accurate and timely completion of my insurance forms. Sherwood Dental has NO knowledge of what is covered by my insurance plan. If I have a booklet, Sherwood Dental will be able to interpret it for me. Many plans require Pre-Determinations to be forwarded for more extensive treatment. Sherwood Dental will complete these for me. To avoid any delays in receiving my payment from my insurance company I must send my claim immediately, if it is not submitted electronically.

    * Sherwood Dental also understands that your time is valuable so we are intent on starting your appointment on time. With the possible exception of short notice emergencies (which all of us might get and we would like to be seen as soon as possible) we will not double book appointments.

    * Sherwood Dental will always make every attempt to see emergency cases promptly.

    * Sherwood Dental will accept Visa, MasterCard, debit, cash or cheque.

    * Sherwood Dental will propose my dental treatment with my long-term dental health in mind, and will do their best to give an accurate estimate.

    Consent for Collection, Use and Disclosure of Personal Information

    * I agree that Sherwood Dental has obtained informed consent from me with respect to the collection, use and disclosure of my personal health information. I can request to see a copy of the consent form and agree the personal information may be collected, used and disclosed as set out in the Privacy Policy of the Office which is in accordance with the Personal Health Information Protection Act, 2004.
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About Sherwood Dental

Our dental practice in Kitchener is conveniently located in the Krug Street Plaza, behind Scotia Bank, with the entrance facing Sherwood Avenue. When you visit our dental office you will experience all that modern dentistry has to offer, including a comprehensive list of general, restorative and cosmetic dental services to meet the needs of your whole family.

5 star review

Kitchener Dentist Office

Sherwood Dental
501 Krug St #113
Kitchener, ON N2B 1L3
519-576-2170
519-576-0338
[email protected]

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