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Dental Exam and Cleaning
Family Dentistry
Dental Emergencies
Mouthguards and Occlusal Splints
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Dental Restorations
TMJ
Periodontics
Denturology
Cosmetic Dentistry
Cosmetic Dentistry
Injection of neuromodulators (Botox®)
CEREC Technology
Crowns and Bridges
Invisalign® Invisible Orthodontics
Teeth Whitening
Surgery
Endodontics
Implantology
Wisdom Tooth Extraction
The clinic
Our team
Visit our clinic
Patient information
Postoperative Instructions
Medical questionnaire
CDCP
Minor Consent Form
Adult Consent Form
Contact us
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450-625-2030
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Our services
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Our services
General Care
Dental Exam and Cleaning
Family Dentistry
Dental Emergencies
Mouthguards and Occlusal Splints
Treatments
Dental Restorations
TMJ
Periodontics
Denturology
Cosmetic Dentistry
Cosmetic Dentistry
Injection of neuromodulators (Botox®)
CEREC Technology
Crowns and Bridges
Invisalign® Invisible Orthodontics
Teeth Whitening
Surgery
Endodontics
Implantology
Wisdom Tooth Extraction
The clinic
Retour
The clinic
Our team
Visit our clinic
Patient information
Retour
Patient information
Postoperative Instructions
Medical questionnaire
CDCP
Minor Consent Form
Adult Consent Form
Contact us
Appointment
450 625-2030
English
Français
(
French
)
Adult Consent Form
Consent form for the collection and use of personal information
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, hereby give my consent to the collection, use and disclosure of my personal information by ESPACE DENTAIRE MD for the purpose of providing me with dental services. I acknowledge that I have received information about how my personal information will be collected, used, shared, stored and protected. I acknowledge that I have received information about my rights regarding my personal information. The preceding information can be found in the ESPACE DENTAIRE MD privacy policy. I understand that consent is valid for as long as I am a patient of ESPACE DENTAIRE MD and that I may withdraw my consent to the collection and use of my personal information at any time in accordance with the procedure described in ESPACE DENTAIRE MD's Privacy Policy. However, this may prevent ESPACE DENTAIRE MD from providing me with dental services. I have read and understood the above information and voluntarily consent to the collection and use of my personal information as described.
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2026-07-31 15:52:26
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