5 WINNIPEG LOCATIONS
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5 Locations in Winnipeg
1-204-774-7774
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Toll Free: 1-866-774-0006

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Locations

693 McPhillips St

British Columbia

Forms

General Dentistry

X-Ray Release Form

Dental

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693 McPhillips Street, Winnipeg MB, R2X 2H6

Mon-Thu: 8AM – 8PM
Fri: 8AM – 7PM
Sat: 8AM – 5PM
Sun: 9:AM – 4PM

249 ½ Henderson Highway, Winnipeg MB, R2L 1M3

Mon-Thu: 10AM – 7PM
Fri: 10AM – 6PM
Sat: 9AM – 5PM
Sun: Closed

246 Portage Ave, Winnipeg MB, R3C 0B1

Mon-Thu: 7AM – 8PM
Fri: 7AM – 6PM
Sat: 7AM – 5PM
Sun: Closed

1531 Pembina Hwy, Winnipeg MB, R3T 2E5

Mon-Thu: 8:00AM – 8PM
Fri-Sat: 8:00AM – 5PM
Sun: Closed

1462 Regent Ave W, Winnipeg MB, R2C 3A8

Mon-Thu: 8:00AM – 7:00PM
Fri: 8:00AM – 5:00PM
Sat: 8:00AM – 5:00PM
Sun: Closed

Have you been to Greenwoods Dental Centre?YesNo

Which office location are you booking for?
693 McPhillips Street249 Henderson Highway246 Portage Avenue1531 Pembina Highway1462 Regent Avenue WestWill Discuss Later

Your Information

This appointment is for myself.This appointment is for someone else.

Your Date of Birth

Patients Date of Birth

Patients under the age of 18 must have a parent or guardian on file.

Parent / Guardian Date of Birth

Insurance Coverage
Private Insurance (ie. Canada Life, Manitoba Blue Cross, Manulife, etc)Non-Insured Health Benefits (NIHB / Treaty)Employment and Income Assistance (EIA)Other (ie. MPI, WCB, etc.)

Any additional information?

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Is this appointment for you, or are you booking for someone else?

Myself Someone else

How are you related to the person you are booking for?

Have you been to Greenwoods Dental & Surgical Centres before?

Yes No

Which location are you looking to visit?

693 McPhillips Street

693 McPhillips St 249 Henderson Highway

249 Henderson Highway

249 Henderson Hwy 246 Portage Avenue

246 Portage Avenue

246 Portage Ave 1531 Pembina Highway

1531 Pembina Highway

1531 Pembina Hwy 1462 Regent Avenue W

1462 Regent Avenue W

1462 Regent Ave W

Will Discuss Later

Will Discuss Later

What is your name?

What is the name of the person you are booking for?

What is the person's date of birth?

Since the person is under 18, we will need your information.

What is your date of birth, {name}?

How can we assist?

When would you like to schedule the appointment?

What is your email address?

Are you covered by dental insurance?

Yes No

Which coverage type?

Private Insurance Non-Insured Health Benefits (NIHB / Treaty) Employment and Income Assistance (EIA) Canadian Dental Care Plan (CDCP) Other (ie. MPI, WCB, etc.) Will discuss later.

Insurance Information

If you are not the policy holder, please comment with the policy holder's name, date of birth, relation to you, and address, as we will require that for billing.

Upload Insurance Document 1: Upload Insurance Document 2: Upload Insurance Document 3: Upload Insurance Document 4:

Are you covered by secondary insurance?

Yes No

Which secondary coverage type?

Private Insurance Non-Insured Health Benefits (NIHB / Treaty) Employment and Income Assistance (EIA) Canadian Dental Care Plan (CDCP) Other (ie. MPI, WCB, etc.) Will discuss later.

Secondary Insurance Information

If you are not the policy holder, please comment with the policy holder's name, date of birth, relation to you, and address, as we will require that for billing.

Upload Secondary Insurance Document 1: Upload Secondary Insurance Document 2: Upload Secondary Insurance Document 3: Upload Secondary Insurance Document 4:

Would you like to update your primary dental coverage?

Yes No

Would you like to update your secondary dental coverage?

Yes No

Any additional information?

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