Receive a Reid's Kitchen or Tim Hortons Gift Card for NEW PATIENT (family) referrals

request an appointment

Monday 9am-4pm

Tuesday 6pm-7pm

Wednesdays 1pm-7:30pm

Thursday 9am-5pm

Friday 9am-5pm

*some Saturdays 9am-2pm

Are you requesting an appointment with Brandie Tilma (yes or no)*

Reason for Appointment: (dental cleaning, dental exam and/or xrays)*

Is this for a New Patient ? (yes or no)*

First AND Last Name of Patient*

First AND Last Name of Parent or Guardian

Birthdate (day/month/year) of Patient*

Phone Number*

Email*

Preference of Day of the Week (Tuesday/Wednesday/Thursday/Friday/Saturday)*

Preference of Time of Day (morning/afternoon/evening/anytime)*

Contact Preference: Phone or Text or Email*

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1796448 Alberta Ltd. o/a Polished Dental Hygiene