Burnaby Heights Dental Centre

New Patient Form

Please complete this form before your appointment. Required fields are marked with an asterisk.

Your privacy matters. Please submit this form only through the clinic's secure connection. Signatures will be completed in person at the clinic.
Section 1

Patient information

Sex *
Do you have dental insurance? *
Section 2

Medical history

Are you currently being treated for a medical condition? *
Have you ever been hospitalized? *
Have you ever had any operations? *
Any physical symptoms we should be aware of? *
Are you a smoker? *
Do you have any allergies? *
Are you pregnant or think you may be pregnant? *

Chronic diseases or conditions

Do you suffer from any chronic diseases or conditions? *
Are you taking any medications? *
Section 3

Dental history

Have you had any head, neck, or jaw injuries? *
Have you had orthodontics or braces in the past? *
Do your gums bleed while brushing or flossing? *
Are your teeth sensitive? *
Do you feel pain in any of your teeth? *
Do you have any sores or lumps in your mouth? *
Do you clench or grind your teeth? *
Have you noticed loosening in any of your teeth? *
Have you ever had any gum treatment? *
Have you ever worn a bite plate or other appliance? *
Have you had any difficult extractions in the past? *
Do you wear dentures or partials? *
Have you had an unfavourable dental experience? *
Section 4

Appointments

Appointment policy: A minimum charge of $50 will be made for a cancelled or no-show appointment without prior notification of 2 business days. Once an appointment is made, please remember this time has been reserved for you.

Section 5

Authorization and release

I certify that I have read and understand the above information to the best of my knowledge. The above questions have been accurately answered. I understand that providing incorrect information can be dangerous to my health. I authorize the dentist to release my information, including the diagnosis and the records of any treatment or examination rendered to me or my child during the period of such dental care, to third-party payers and/or health practitioners. I authorize and request my insurance company to pay directly to the dentist or dental group insurance benefits otherwise payable to me. I understand that my dental insurance carrier may pay less than the actual bill for services. I agree to be responsible for payment of all services rendered on behalf of me or my dependants.

Patient or guardian and dentist signatures will be completed in person at the clinic.

form

Your First Visit - Overview

Your First Visit - Overview

If this is your first visit to Burnaby Heights Dental Care, welcome! We want your initial experience with Dr. Katy Anagnostou D.D.S. and her dedicated team to be a positive one. Below, we have mapped out what new patients should at the first dental visit. If you have any questions, please contact us at 604-320-7321.


During your first visit to Burnaby Heights Dental Care, our dentist will perform a comprehensive oral exam, including a visual assessment, periodontal (gum health) evaluation, and diagnosis. As part of the visual portion, Dr. Anagnostou D.D.S. will examine your teeth closely, look at the anatomy of your mouth and supporting structures. We may also use digital imaging to uncover cavities, bone loss, and other dental issues. An oral cancer screening may also be done. X-rays will be taken if they have not been updated in the last couple of years. These are crucial steps that allow us to detect any budding oral health threats that can be detected early when problems are easier to treat. We also look for issues with your bite.


In addition to your cleaning, our dentist will complete a periodontal exam during your first visit. It is important to check gum health and diagnose signs of gum disease. You will get your teeth polished for stain and plaque removal, and fluoride varnish applied for cavity prevention. Our team will then demonstrate to you how to effectively brush and clean in between your teeth. You will also receive a complimentary toothbrush and toothpaste package to take home.


After your initial exam is finished, Dr. Anagnostou D.D.S. will review her findings with you and discuss the state of your oral health. At that point treatment recommendations will be made to correct any problems detected. Our dental team will go over your options, so you can make an educated decision about your care. We encourage patients to discuss any oral health concerns or questions about treatment options.

A woman smiling in dental clinic

Ready to
book your visit?

Ready to
book your visit?

Whether you need a routine checkup, FASTBRACES®, cosmetic care, implants, or help with a dental concern, Burnaby Heights Dental Centre is here to guide your next step with comfort and clarity.

Whether you need a routine checkup, FASTBRACES®, cosmetic care, implants, or help with a dental concern, Burnaby Heights Dental Centre is here to guide your next step with comfort and clarity.

Book Your Appointment

Book Your Appointment

Book Your Appointment

Book Your Appointment

Book Your Appointment

Book Your Appointment