Screening Registration Card
Adult Clinic
For treatment for a child under 12 years of age, please call the Children’s Clinic to register: 519.661.3329, or complete this Children's Clinic screening card.
For straightening of teeth/braces, please call the Orthodontic Clinic to register: 519.661.3558
If you are in moderate or severe pain, please call the Emergency Clinic at 519.661.3331 to schedule an appointment.
If you are only interested in having your teeth cleaned, please reach out to the Fanshawe College Dental Hygiene Clinic.
IMPORTANT: If you wish to become a patient at the Schulich Dentistry Clinics, we invite you to complete the form below. Please note that we are unable to accept patients with an artificial heart valve, previous heart infection, had a heart attack within the last 6 months, or who require prophylactic antibiotics for every dental appointment. You must also be available for 3-hour appointments on a regular basis throughout the academic year.
If unable to communicate effectively in the English language, you must bring a translator with you to your screening appointment.
