Powered by
IcyCRM
appointment request
First Name
*
Middle Name
Last Name
*
Home Phone
*
Work Phone
Mobile Phone
Email
Book Appointment With:
*
North Toronto Dental Centre
Scarborough Dental Centre
Stouffville Dental Centre
Dr. Paul Mirkopoulos - North Toronto
Dr. Nick Miliotis - North Toronto
Dr. Fehmida Dosani - North Toronto
Lenna Klasios - North Toronto
Vaishali Duphere - Scarborough
Dr. Paul Mirkopoulos - Scarborough
Vaishali Duphere - Scarborough
Lenna Klasios - Scarborough
Dr. Ali Khadivi - Stouffville
Dr. Fehmida Dosani - Stouffville
Joel Feinstein - Stouffville
Stella Loukas - Stoufville
Request your Appointment with SmileWork
Are you a current patient with SmileWork?
*
Yes
No
First-time patients, please fill and submit your Health Information Form Online!
Most Convenient Day of Week
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Most Convenient Time of Day
Mornings 8:00-11:00
Lunch 11:00-1:00
Afternoon 1:00-4:00
Evenings 4:00-8:00
Preferred Day For Appointment ( day and month )
2nd choice ( day and month )
You can email a short note