Schedule a dental appointment request

Please complete the form below and click on the send button. Please note that fields marked with * are mandatory.

How we use the data you send?

By completing this form and clicking on the send button, you consent to us using this data to contact you to arrange a dental appointment. For further information:


1. Tell us about you *

2. Best way to contact you

3. Type of appointment

4. Availability

5. Comments

We will contact you as soon as possible after receiving your request.

Summary of the clinic's internet privacy policy for online appointments

The personal data collected from this form (surname, first name, telephone number and e-mail address) is used to:

  • contact you in response to your request for a dental appointment,
  • to link your request, if necessary, to your patient file in our computerized dental care system.

We respect your privacy and undertake not to use this information for any purposes other than those mentioned above. The data collected in this way will be kept on our computer system for one month before being deleted.

You may contact Annabelle Laurin at protection_rp(a)cliniquebfabre.com to request that your data be modified or deleted before this period expires.