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  • About
    • Core Values
    • Surgeons
    • Retired Surgeons
    • How We Work with Your Dentist
    • What is an Oral & Maxillofacial Surgeon (OMFS)
    • Community Impact
  • Procedures
    • Wisdom Tooth Removal
    • Dental Implant
      • Teeth in a Day
      • Zygomatic Implants
    • Bone Grafting
    • Impacted Canine Teeth Treatment
    • Cleft Lip & Cleft Palate Surgery
    • Dental Extractions
    • Facial Trauma
    • Corrective Jaw Surgery
    • Head Neck Oral Cancer
    • Digital Dentistry
  • For Referring Doctors
    • Referral Form
    • Educational Events
      • Education Day
      • 2019 Education Day
  • For Patients
    • Accessibility Pledge
    • Code of Conduct
    • Health Questionnaire
    • Insurance and Payment Information
    • What To Expect
    • Your Privacy & Security
  • Resources
    • About Your First Visit
    • Anaesthesia
    • Blog
    • Dental Implant Information
      • What to Expect During Dental Implants Surgery
      • Dental Implants Pricing
    • Frequently Asked Questions
    • Surgical Instructions
      • Pre-Operation Surgical Instructions
      • General Post-Operation Surgical Instructions
      • Dental Implant: Post-Operation Instructions
    • Video Gallery
    • Wisdom Teeth Information
      • Do I Need My Wisdom Teeth Removed?
      • Do I Need a Referral for Wisdom Teeth Removal
      • Booking & Appointment Process
      • The Initial Consultation
      • Pre-Operation Surgical Instructions
      • How Much Does Wisdom Teeth Removal Cost?
    • Bone Grafting Information
  • Locations
    • Barrhaven
    • Carling & Surgicentre West
    • Kanata
    • Orleans & Surgicentre East
  • Contact
  • Refer A Patient
argyle
  • Refer A Patient
  • About
    • Core Values
    • Surgeons
    • Retired Surgeons
    • How We Work with Your Dentist
    • What is an Oral & Maxillofacial Surgeon (OMFS)
    • Community Impact
  • Procedures
    • Wisdom Tooth Removal
    • Dental Implant
      • Teeth in a Day
      • Zygomatic Implants
    • Bone Grafting
    • Impacted Canine Teeth Treatment
    • Cleft Lip & Cleft Palate Surgery
    • Dental Extractions
    • Facial Trauma
    • Corrective Jaw Surgery
    • Head Neck Oral Cancer
    • Digital Dentistry
  • For Referring Doctors
    • Referral Form
    • Educational Events
      • Education Day
      • 2019 Education Day
  • For Patients
    • Accessibility Pledge
    • Code of Conduct
    • Health Questionnaire
    • Insurance and Payment Information
    • What To Expect
    • Your Privacy & Security
  • Resources
    • About Your First Visit
    • Anaesthesia
    • Blog
    • Dental Implant Information
      • What to Expect During Dental Implants Surgery
      • Dental Implants Pricing
    • Frequently Asked Questions
    • Surgical Instructions
      • Pre-Operation Surgical Instructions
      • General Post-Operation Surgical Instructions
      • Dental Implant: Post-Operation Instructions
    • Video Gallery
    • Wisdom Teeth Information
      • Do I Need My Wisdom Teeth Removed?
      • Do I Need a Referral for Wisdom Teeth Removal
      • Booking & Appointment Process
      • The Initial Consultation
      • Pre-Operation Surgical Instructions
      • How Much Does Wisdom Teeth Removal Cost?
    • Bone Grafting Information
  • Locations
    • Barrhaven
    • Carling & Surgicentre West
    • Kanata
    • Orleans & Surgicentre East
  • Contact

Health Questionnaire

Contact Us

If this is your first time choosing Argyle Associates for your oral surgery in Ottawa, here’s what you can expect. Your first visit will be a consultation. This is your chance to meet your surgeon, learn more about your surgery and ask any questions about the procedure or fees. This will also be our chance to review your medical and dental history and take any x-rays needed. The purpose of this appointment is to make sure you’re feeling comfortable about your procedure and to ensure our team is fully prepared for the day of the surgery. This consultation usually lasts between 45 and 75 mins, please arrive 15 mins early to check-in.

 

FAQs

"*" indicates required fields

The following information is confidential and for our records only.

Last Name
First Name
Middle Initial
Marital Status
Gender
MM slash DD slash YYYY
MM slash DD slash YYYY
Phone
Do you live alone?*
Are you seeing a dental specialist other than us? (Orthodontist, Periodontist, Endodontist)*

FOR PRESCRIPTION PURPOSES / EN RAISON DE PRESCRIPTIONS

Or

HEALTH QUESTIONNAIRE

1. Are you in good health?*
2. Are you presently having pain or difficulty with your teeth or your jaw?*
3. Are you on any medications?*
4. Do you have any known allergies?*
5. Do you Smoke or Vape?*
6. Have you ever had abnormal bleeding tendencies?*

Have you been treated in the past for:

7. Diabetes*
8. Heart Trouble*
9. Epilepsy*
10. Kidney Disease*
11. Rheumatic Fever*
12. Hepatitis*
13. Asthma*
14. HIV+*
15. Hypertension*

Have you ever been diagnosed with:

16. Lung Problems (Asthma, Emphysema, Bronchitis, other)*
17. Stroke*
18. Problems with your immune system (HIV/AIDS, Steroid Use, Lupus)*
19. Cancer (Chemotherapy, Radiation Therapy)*
20. Osteoporosis*

22. Do you snore?*
23. Do you stop breathing when you sleep?*
24. Have you ever been diagnosed with Sleep Apnea?*
25. Do you use a CPAP machine?*
26. Do you currently, or have you in the past, used prescription narcotics, street drugs or marijuana recreationally?*
28. Do you consume cannabis (in any form - smoke, edibles, etc.)?*
30. Are you now or have you ever been treated for drug addiction or alcoholism?*
31. Are you subject to neurological disorders? (Multiple Sclerosis, Parkinson's Disease, Alzheimer's Disease, etc.)?*
32. Have you ever had general anaesthetic?*
33. Have you or your family ever had complications during an anesthetic?*
34. Do you have dizziness or shortness of breath?*
35. Is there anything special about you or your family's physical condition that should be called to the doctor's attention?*
36. Are you pregnant?*
37. Do you wear contact lenses?*
38. Are you highly afraid of needles?*
39. How did you hear about us?*

Contact Us Today

We will have one of our trained professionals get back to you as soon as possible.

Contact Us!

About Us

Argyle Associates Oral & Maxillofacial Surgeons is one of the largest, most established groups of its kind in Canada. Since 1976, we have provided the complete scope of oral and maxillofacial procedures.

Our Locations

BARRHAVEN:10-3091 Strandherd Drive
Barrhaven, ON K2G 4R9


ORLEANS & SURGICENTRE EAST: 750 Taylor Creek Drive
Orleans, ON K4A 0Z9

Our Locations

CARLING & SURGICENTRE WEST: 100‐2255 Carling Avenue
Ottawa, ON K2B 7Z5


KANATA: 15‐499 Terry Fox Drive
Kanata, ON K2T 1H7

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