Tell us about your little one

Child's first name

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Child's last name

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Date of birth

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What do they like to be called?

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Is this their first dental visit ever?

Yes — first ever! No — first visit with you

How do they usually handle new experiences?

Jumps right in Warms up slowly Gets anxious Depends on the day

What do they love?

Dinosaurs? Bluey? Hockey? We'll use it — a chat about T-Rex teeth breaks a lot of ice.

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Health & habits

Does your child have any of these?

Allergies Asthma Heart condition Developmental or sensory needs Medications they take regularly None of these

Tell us what helps your child succeed

Quiet room? Extra time? A specific approach? Our pediatric specialist, Dr. Maniate, plans visits around exactly this.

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Any of these habits?

Thumb / finger sucking Pacifier Bottle at bedtime Grinding at night None of these

Any concerns about their teeth?

Spots, discolouration, thumb-sucking worries, a bumped tooth — anything at all.

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Parent details & booking

Your name

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Relationship to child

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Phone

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Email

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Best times for your child

Morning (fresh & rested) After nap / midday After school Saturday (select dates)

A parent or guardian must accompany children at their visit. The CDA recommends a first assessment within 6 months of the first tooth, or by age one — earlier than most parents expect, and we love meeting babies.

Children's First Visit

Tell us about your little one

Health & habits

Parent details & booking

Can't Wait to Meet Them!