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:
– TDownload 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:
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!