Patient Info

Icon representing dental instruments.

Your Dental Health

A priority for our entire team.

Patient Info

Following an Intervention

First Visit Form

Before your first appointment at the clinic, you will have to fill out a form that gives us all the relevant information concerning your health. To speed things up, we ask that you fill out the form at home or send it to us online.


If you must cancel your appointment, please inform us by telephone or e-mail at least 48 hours in advance. Otherwise, you will be charged a service fee.


To fill out the paper form:

  -  Download the form (PDF format).

  -  Fill out the form and print it.

  -  Bring it with you for your first appointment.


To fill out the form online:

Confidential Medical-Dental Questionnaire

The dental file will be used within the context of the care that is provided The information is protected by law and by professional secrecy. It will be kept at the office, and only the dentists and their staff will have access to it. The patient also has the right to access and correct the information.

Personal information

F
M
Parent or
Guardian

Contact in case of emergency:

Medical history

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

Have you suffered form or are you currently suffering from any of the following:

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Normal
Low
High
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

Have you ever had an allergic reaction to any of the following products?

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

Other aspects

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Occasional
Yes
No

Dental information

0-6 months
6-12 months
More than 12 months
Yes
No
Yes
No

Have you ever undergone any of the following dental treatments or services?

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

For professional use only:

Make an Appointment

To make an appointment, you can call us at 450-437-6446 or fill out the following online form


If this is your first visit, click here to open a medical file.


We will contact you soon by phone or by e-mail to confirm your appointment or to suggest a different time.

Making an appointment

Monday
Tuesday
Wednesday
Thursday
Friday
Morning
Afternoon
Evening

Personal information

Make Your Life Easier With Dental Insurance

No need to worry: clinique dentaire Caroline Provencher will take care of sending your dental insurance forms electronically. In most cases, the amount that is accepted for your dental treatments is sent almost immediately. All you have to pay when you visit the dentist is the deductible and the percentage that your insurer does not cover.


Insurance coverage varies depending on the agreement between the insurance company and your employer. We are not legally permitted to overcharge your insurance company or not collect the difference from you. Therefore, it is your responsibility to familiarize yourself with your coverage and the maximum amount that you can claim per year.


For patients whose insurance forms cannot be sent electronically, we will fill them out quickly and hand them back to you. You can then pay the fees at the clinic and send the duly completed forms to your insurer. Upon request from your insurer, we will be happy to provide a treatment plan or an estimate.

Dental services covered by the RAMQ

Our clinic is a member of the Québec health insurance plan administered by the Régie de l’assurance maladie du Québec (RAMQ), which covers certain services for children under the age of 10 years, along with recipients of last-resort financial assistance and their dependants. Consult this flyer to learn more!

Post-treatment survey

In our ongoing effort to improve the quality of our services, we invite our clients to respond to a short survey. The objective of this new approach is to measure your level of satisfaction and determine which aspects of our practice can be improved. Please note that the survey is anonymous.

Refer to a friend

Are you very satisfied with the care that you received at our clinic? Thank us by referring us to someone you know.

Following an intervention

Minor surgery or tooth extraction

  • Keep the compresses in your mouth for 30 or 40 minutes, maintaining firm pressure. Change the dressing every 30 minutes, as needed.

  • Keep your head elevated.

  • Apply ice or a cold-water compress to your cheek at regular intervals (20 minutes every hour).

  • If there is bleeding, apply some gauze or a moistened tea bag and bite down on it for approximately 20 minutes.

  • Some bleeding and colour in the saliva is normal after surgery.

  • Limit your physical effort, and be sure to rest.

To be avoided:

  • Don’t remove any clotted blood because it facilitates the healing process.

  • Do not eat until the wound has stopped bleeding.

  • Do not drink through a straw.

  • Do not rinse your mouth out or spit.

  • Do not smoke or drink alcohol.

  • Eat only soft foods.

  • Do not brush your teeth near the wound for the first 72 hours.

Pain:

  • If you experience pain, take the prescribed medication.

  • If the dentist has prescribed antibiotics, take them until the prescription is finished, even after the symptoms have disappeared.

Diet:

  • Consume only soft foods and warm liquids on the day of your surgery. Return to your normal diet when you feel up to it.

From the day after your surgery until you are fully healed:

  • Rinse your mouth three times per day with warm water and salt (2 ml or 1/2 tsp. of salt in 250 ml or 1 cup of water).

  • Brush your teeth and floss every day in order to eliminate plaque and ensure the best results over the long term.

  • Avoid hard foods (nuts, candies, ice cubes, etc.).

  • Some patients notice increased saliva production and a change in their pronunciation. These symptoms should subside within a week.

  • Bruises may appear on your skin. They should clear up within 5 to 7 days.

  • It may be more difficult to open your mouth. Things should return to normal within 4 or 5 days.

  • If the pain increases after 3 days instead of decreasing, contact your dentist.

You should feel better in a few days, and can return to your normal activities. If you continue to feel pain, bleed profusely, remain swollen for 2 or 3 days, or experience a reaction to the medication, please contact the clinic immediately, at 450-437-6446.

Call Us If You Have Any Concerns

CLINIQUE DENTAIRE CAROLINE PROVENCHER
116, chemin de la Grande-Côte
Boisbriand (Québec) J7G 1C2

(Exit 19 off Autoroute 15)

BUSINESS HOURS

Monday to Wednesday, 9:00 AM to 9:00 PM 

Thursday and Friday, 8:00 AM to 4:30 PM

Saturday, by appointment 

(Contact us to make an appointment).

Send to a friend

Send the url of this page to a friend of yours

Created by

Legal notice