Scheduling

Office Hours

Monday through Thursday:   9:00 AM - 4:00 PM
Friday:   9:00 AM - 12:00 PM

We will schedule your appointment as promptly as possible. If you have pain or an emergency situation, every attempt will be made to see you that day.

We try our best to stay on schedule to minimize your waiting. Due to the fact Dr. Munce provides many types of endodontic services, various circumstances may lengthen the time allocated for a procedure. Emergency cases can also arise and cause delays. We appreciate your understanding and patience.

Please call us at Advanced Endodontics Phone Number (905) 632-3456 with any questions or to schedule an appointment.

Dr. Munce/Advanced Endodontics. Medical Questionnaire

Name(Required)
Name(Required)
In case of Emergency, we should notify:
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Address (Home)
Address (Business)
Name of Medical Specialist
The following information is required to enable us to provide you with the best possible dental care. All information is strictly private, and is protected by doctor-patient confidentiality. The dentist will review the questions and explain any that you do not understand. Please fill in the entire form.
Are you currently being treated for any medical condition or have you been treated within the past year? If yes, please explain?
Has there been any change in your general health in the past year? If yes, please explain.
Are you taking any medication, non-prescription drugs or herbal supplements of any kind? If yes, please list them.
Do you have any allergies? If yes, please list them using the categories below:
Have you ever had a peculiar or adverse reaction to any medicines or injections? If yes, please explain.
Do you have or have ever had asthma?
Do you have or have you ever had any heart of blood pressure problems?
Do you have or have you ever had a replacement or repair of a heart valve, an infection of the hear (i.e. infective endocarditis), a heart condition from birth (i.e. congenital heart disease) or a heart translplant?
Do you have a prosthetic or artificial joint?
Do you have any conditions or therapies that could affect your immune system (e.g. leukemia, AIDS, HIV infection, radiotherapy, chemotherapy)?
Have you ever had hepatitis, jaundice, or liver disease?
Do you have a bleeding problem or bleeding disorder?
Have you ever been hospitalized for any illnesses or operations? If yes, please explain
Do you have or have you ever had any of the following? Please check.
Are there any conditions or diseases not listed above that you have or have had? If yes, please explain.
Are there any diseases or medical problems that run in your family (e.g. diabetes, cancer or heart disease)?
Do you smoke or chew tobacco products?
Are you nervous during dental treatment?
Are you breastfeeding or pregnant? If pregnant, what is the expected delivery date?
Do you identify as a patient with a disability? If yes, please explain.
To the best of my knowledge, the above information is correct:
Patient/Parent/Guardian Signature:
Please fill in current date of completion:
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This field is for validation purposes and should be left unchanged.