DOWNLOADABLE FORMS 

In an attempt to save the environment, we are on route to being paperless. 

You can download these forms and bring them along on the date of your appointment. We appreciate your help in our cause.

Patient referral pads for Dentists

Please download the form and fill it out, once completed please attach it to the email and send it via the submit button below.

Patient MEDICAL HISTORY FORM

Please download the form and fill it out, once completed please attach it to the email and send it via the submit button below.

Patient Insurance Claim form Brampton Office

Feel free to download this form to send to your insurance company

Patient Insurance Claim form Mississauga Office

Feel free to download this form to send to your insurance company

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Please Support the Drs. Eckler, Black & Leung's Sick Kids Fund at the Hospital for Sick Children by clicking on the icon below:

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