info@greenwoodsdental.com
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693 McPhillips St | 8:00 AM – 8:00 PM
Locations
Winnipeg
693 McPhillips Street 249 ½ Henderson Hwy 1531 Pembina Hwy 246 Portage Ave 1462 Regent Ave W Pediatric Centre
British Columbia
Vancouver Prince Rupert Masset, Haida Gwaii Fort St. John
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Greenwoods Dental & Surgical Centres
Three Pillars →
Nonmaleficence Patient Care Patient Experience

Forms

The forms listed below are the exclusive property of Greenwoods Dental & Surgical Centres™ and have been created by our team with the utmost care and expertise. These forms are provided solely for the purpose of accurately recording the necessary information and obtaining signatures. Any modification, alteration, or unauthorized change to the content, structure, or design of these documents is strictly prohibited.

Users are permitted only to fill in the required information and sign the forms as provided. Any other form of alteration—including but not limited to editing text, reformatting, or incorporating additional content—is not allowed and may be subject to legal action. By using our forms, you acknowledge and agree to abide by these terms, ensuring that the integrity and proprietary nature of our documents remain intact.

For any questions or requests regarding the appropriate use of these forms, please contact us.

Release Forms

Credit Card Authorization

This form authorizes the secure processing of your credit card payment for specified transactions.

Credit Card Authorization Form
Medical History Form

This form authorizes the collection and review of your medical history, including illnesses, medications, and allergies. The information helps healthcare providers deliver safe and appropriate care. All details are kept confidential and used only for medical purposes.

Medical History Form
Staff Time Off Request

Submit a request for vacation, sick leave, or personal time. Your manager will review and approve or deny the request.

Time Off Request

Fox X-Ray Release Forms

Please select the appropriate option below to complete and submit your X-ray release authorization.

General X-Ray Release

Standard authorization form to request and release patient X-ray records.

Complete Release Form

X-Ray Release to Greenwoods (GWD)

Authorization form specifically to transfer and release X-ray records directly to Greenwoods Dental Centres.

Release to GWD Form
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