Patient Forms

Same Day Appointments

Call The Office

(780) 429-1076

Clinic Location

#203, Stantec Tower, Edmonton

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First-Time Patient?

Call (780) 429-1076

New Patient First Visit

When you book your first appointment with us, our front-end co-ordinator, Rosie, will email you a link to our online new patient forms. Fill them out and submit them prior to your first visit. We will also have forms available at our front desk. Finally, remember to arrive 15 minutes early to if you plan to fill out the forms in our clinic.

As a new patient at District Dental, you can expect our friendly staff to greet you and your dental team to conduct a new patient exam. This may include:

  • x-rays
  • photos
  • extra- and intra-oral exam

These procedures help us develop a personalized treatment plan for your dental goals. Also during your first visit, your hygienist will assess your gum health and provide treatments to help you reach your optimal oral health.


Patient Forms and Questionnaires

To help Dr. Stas Pavlenko with diagnoses and treatment, please fill out the appropriate questionnaires. You have the option of downloading and printing your questionnaires. Or filling out and submitting online.

Kids Sleep Questionnaire

Sleep Questionnaire

Bed Partner Questionnaire

TMJ Questionnaire

Smile Design Questionnaire

Stay informed

Subscribe to the District Dental newsletter. Access is free and we will never spam you. When you join, you’ll receive information relevant to you and your family. Information such as the latest techniques and technology, team updates, contest, and more.


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Contact Us Today
or Book An Appointment Online

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Monday: 8am – 4:30pm
Tuesday: 8am – 4:30pm
Wednesday: 8am – 4:30pm
Thursday: 8am – 4:30pm
Friday: 8am – 4:30pm

Working Hours

Monday-Friday 8am-4:30pm.

Free Consultation