New Patient Forms

The following forms can be downloaded to your computer and printed at home.
By filling out these forms ahead of time you will save significant time of your visit. If you have any questions when filling out the form, please do the best you can, and our staff will assist you with your questions on the day of your appointment.

Dental History Questionnaire 9 KB
Medical History Questions 45 KB
Patient Consent Form 5 KB
Patient Consent Personal Info 18 KB

Technical Note:
Our online forms use the Adobe Acrobat Plugin.
Please download the free plug-in from Adobe's website if it is not already installed on your system. It is important that you have the latest version, in order to open our forms.

Dentistry on Jane - Vaughan Family Dentist

Dr. Musa Musa

117 - 9441 Jane Street, Maple, ON, L6A 4H8
Phone: (905) 303-5519