Book Dentist v2 Appointment

In order to plan an appointment and dental cares during the current sanitary context, please complete this regulation form first for the safest workflow.
New patients are welcome but we have to prioritize requests. Many thanks for your understanding.

First Name - Last Name *

Prénom

Nom

Birth date mm/dd/aaaa *

Your last appointment with us ? *

Less than one year More than one year I am a new patient

Do you have the french Sécurité Sociale Health Card ? *

How can we help you ? *

Is it an emergency ? *

Yes No

Do you take pain killers ? *

Yes No

When is it painful ? *

24 hours a day ? Sometimes ? When eating ?

Booking an appointment