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Who are we?
How does it work?
Why choose us?
For Patients
For Partners
FAQs
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This only takes 2 minutes of your time.
Client Application Form
Client Application Form
Client Application Form
Client Application Form
Congratulations!
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Tell us about yourself
First Name
Last Name
User Contact
Email
Phone Number
Address
City
Province
Postal Code
User Age
What is your date of birth?
User Age
Treatment information
Name of Clinic Preferred
Alberta DNA Collection Services Ltd.
Allard Station Dental
Bonnie Doon Dental Associates
Cavanagh Dental
Clareview Village
Clearwater Dental
Dental Wellness Centre of St.Albert
Devon Dental Centre
DNA Testing Centres of Canada- Edmonton
DNA Testing Centres of Canada- Oakville
Downtown Toronto Wellness
Edgemont Dental
Forest Lane Dental
Fort McMurray Dental
Gateway Village Dental
Griesbach Dental
Harvest Hills Dental
Heritage Valley Dental
High Prairie Dental Centre
Holyrood Dental
Kucey Dental Group
London Square Dental
Love Dental Beddington
Love Dental Panorama
MacEwan Dental
Martindale Smiles Dental
Morrison Dental
My Dentist
My Smile Family Dental
Nova Denture & Implant Centre
ONE67 Dental
Our Dentist
Pyramid Dental
Queen Street Dental
Redstone Smiles Dental
Rocky Mountain Dental
Sherwood Park Dental
Sierra Springs Dental
Smile Zone
Stadium Dental
Summit Dental
Timberlea Dental
Uptown Dental
West Wind Dental
Winnipeg North Dental
Yellowhead Dental
Other
Other Clinic Name
When would you like to book your appointment?
Do you currently have health coverage?
Yes
No
Employment information
What is your current source of income?
Full Time
Part Time
Contractual
Seasonal
Self-employed
Fixed Income
Other
Other source of income
How long have you been with your current employer?
Less than 3 months
3 months to 1 year
More than 1 year
Who is your employer?
What is your employer's phone number?
Financial information
What is your hourly wage or monthly salary?
What is your pay frequency?
Biweekly
Monthly
Semimonthly
Weekly
When is your next date of pay?
Do you currently rent or own your own property?
Rent
Own
How much is your rent/mortgage per month?
Final step
BY CLICKING ON THE “AGREE” BUTTON IMMEDIATELY FOLLOWING THIS NOTICE, YOU:
Acknowledge the terms and conditions and privacy disclaimer of this website, which explains how EP Care uses and protects your personal information, as applicable.
Consent to EP Care to perform a soft credit inquiry, which will not affect your credit score.
Agree that EP Care and its affiliates can communicate with you using Email, SMS and Phone and you understand that you can opt-out at anytime.
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