519-542-8876smile@davismilnedentistry.ca

Welcome
Meet Your Dentists
- Dr Karen Davis
- Dr John Milne
Our Team
Dental Services
Service Area
- Sarnia
Blog
Testimonials
New Patients
Contact
Write A Review

Welcome
Meet Your Dentists
- Dr Karen Davis
- Dr John Milne
Our Team
Dental Services
Service Area
- Sarnia
Blog
Testimonials
New Patients
Contact
Write A Review

Sarnia Dentists Near Me Accepting New Patients - All Ages Welcome

Our Philosophy

At Dr. Karen Davis Dentistry in Sarnia, our office and dentists remain dedicated to providing optimal care for every patient and working with you to achieve that goal. Our dentists pride ourselves in helping you in every way possible to provide the quality of care to which you have become accustomed.

How Our Office Helps

As part of our commitment to outstanding customer service, we will:

The dentists will work with you to achieve the maximum reimbursement to which you are entitled
Complete and submit insurance forms on your behalf
Provide you with accurate and timely information about any fees not covered by your plan

Restoring Your Smile's Natural Beauty

Both dentists, Dr. Karen Davis and Dr. John Milne, are devoted to restoring and enhancing the natural beauty in every smile using the latest technology. As family dentists in Sarnia, we provide comprehensive treatment planning, using restorative and cosmetic dentistry, to achieve your optimal overall health. Should an emergency occur, we promise to make every effort to care for you as best possible!

We are true believers that preventative care and education is the gateway to your optimal health. Both dentists, Dr. Karen Davis and Dr. John Milne, are devoted to restoring and enhancing the natural beauty in every smile using the latest technology.

As your dental health professionals, we want you to be confident knowing that we pride ourselves in providing the excellent care and experience you deserve at every visit! Our entire team of business managers, dental hygienists, and assistants is committed to extensive continuing education and higher learning on a yearly basis.

Please fill out and submit our new patient form below. If you have any questions about the form or our dental services, feel free to give us a call.

Medical History and Patient Information

First Name:(Required)

Last Name:(Required)

Date of Birth:(Required)

MM slash DD slash YYYY

Address:(Required)

City:(Required)

Province:(Required)

Postal Code:(Required)

Home Phone:(Required)

Business:(Required)

Cell:(Required)

Text:(Required)

Yes

Email:(Required)

Physician:(Required)

Physician's Phone:(Required)

Previous Dentist:(Required)

Emergency Contact:(Required)

Relationship:(Required)

Phone Number:(Required)

The following information is required to help us provide you with the best possible dental care. All information is confidential.

Health History

Please check Yes or No for the following:

Do your gums bleed?(Required)

Yes

Do you have any dental concerns at this time?(Required)

Yes

Are your teeth sensitive to touch, temperature or sweets?(Required)

Yes

Have you ever had periodontal (gum) treatment?(Required)

Yes

Have you ever had orthodontic treatment/braces?(Required)

Yes

Do you suffer from frequent headaches/jaw pain?(Required)

Yes

Do you suffer from dry mouth?(Required)

Yes

Do you have implants?(Required)

Yes

If you wear full or partial dentures, are they comfortable and fit well?(Required)

Yes

When was your last dental check-up/cleaning?(Required)

Yes

When did you last have any dental radiographs?(Required)

Yes

Please explain in detail all “YES” answers.(Required)

Health History

When was your last medical check-up?(Required)

Reason?(Required)

Please check YES or NO for the following:

Have you experienced any changes to your general health in the past year?(Required)

Yes

Have you been treated for any medical conditions in the past year?(Required)

Yes

Have you been hospitalized for any illness or operation?(Required)

Yes

Have you ever been advised to take antibiotics before dental treatment?(Required)

Yes

Have you ever had an adverse reaction to any medications or injections?(Required)

Yes

Do you have any allergies?(Required)

Yes

Do you bleed easily?(Required)

Yes

Are you pregnant or breastfeeding?(Required)

Yes

Please explain in detail any “YES” answers.(Required)

Are you currently taking any medications, including prescription, over the counter, and natural health products?(Required)

Yes

Drug Name(Required)

Amount, Dose, Frequency(Required)

Reason(Required)

Do you have any of the following medical conditions?

CARDIOVASCULAR/RESPIRATORY

Angina(Required)

Yes

Heart valve problems(Required)

Yes

Congenital heart defects(Required)

Yes

Congestive heart failure(Required)

Yes

Heart disease(Required)

Yes

Chest pain(Required)

Yes

Rheumatic Fever(Required)

Yes

Heart attack(Required)

Yes

Heart murmur(Required)

Yes

Blood pressure problems(Required)

Yes

Artificial heart valves(Required)

Yes

Mitral valve prolapse(Required)

Yes

Heart surgery/Transplant(Required)

Yes

Pacemaker(Required)

Yes

Shortness of breath(Required)

Yes

Asthma(Required)

Yes

Tuberculosis(Required)

Yes

Sinus problems(Required)

Yes

Chronic cough(Required)

Yes

Emphysema/Chronic bronchitis(Required)

Yes

HAEMATOLOGICAL (BLOOD)

Transfusion(Required)

Yes

Abnormal bleeding/bruising(Required)

Yes

Blood disorder(Required)

Yes

Lupus(Required)

Yes

ENDOCRINE/DIGESTION

Diabetes(Required)

Yes

If so, what type?(Required)

Thyroid disease(Required)

Yes

Dietary restrictions/Eating disorder(Required)

Yes

GASTROINTESTINAL/URINARY

Hepatitis, Jaundice, Liver disease(Required)

Yes

Acid reflux/Heart burn(Required)

Yes

Kidney disease(Required)

Yes

Stomach ulcers(Required)

Yes

NEUROLOGICAL/MUSCULAR SKELETAL

Stroke(Required)

Yes

Seizure disorder(Required)

Yes

Arthritis(Required)

Yes

Osteoporosis(Required)

Yes

Mental health disorder(Required)

Yes

Joint replacement(Required)

Yes

OTHER

Do you use tobacco products?(Required)

Yes

Do you have a drug/alcohol dependency?(Required)

Yes

Do you have any vision problems?(Required)

Yes

Please explain in detail to any “YES” answers.(Required)

Patient Vital Signs:

Blood Pressure:

Pulse Rate:

To the best of my knowledge, the above information is correct.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

2017 Winner of Book Local Community Choice Award

Dr. Karen Davis Dentistry is ranked as a top dentist in Sarnia, Ontario

Verified by Opencare.com

patient-preferred-physician-practitioner-dr-karen-davis-sarnia (1)

2019 OBAA Outstanding Customer Service Award Nominee Dr Karen Davis Dentistry

Dr Karen Davis Dentistry
1350 L'Heritage Drive
Sarnia, ON N7S 6H8
(519) 542-8876
smile@davismilnedentistry.ca