Dental History Form

If you have any questions, please call our office at 204-837-4517.

Dental History

PLEASE ANSWER YES OR NO TO THE FOLLOWING:

PERSONAL HISTORY
SMILE CHARACTERISTICS
BITE AND JAW JOINT
TOOTH STRUCTURE
GUM AND BONE

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What Our Patients Say About Us

Dr. Shah is wonderful, he did an amazing job on my veneers! I finally have a smile that I love, for the first time in my life. The staff here are always so friendly and accommodating, and ever since I started coming here, I actually find myself looking forward to dental appointments! I highly recommend Westwood Dental

– LISA DARKWING

Where To Find Revive Dental At Westwood 

3216 Portage Ave

Winnipeg, MB

R3K 0Y8

204-837-4517

Revive Dental Winnipeg

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone. Our scheduling coordinator will confirm your appointment.