Your Edmonton Family Dental Clinic
Mon - Tues 7am - 3pm , Wed - Thurs: 7am - 8pm, Fri 8am - 4pm

Patient Forms

During the current Covid-19 situation, we kindly request that all current and new patients complete and return via email the appropriate form to glenora@glenoradental.com

Emergency Patient Forms

During the current Covid-19 situation, we kindly request that all current and new patients complete and return via email the appropriate form to glenora@glenoradental.com

Emergency New Patient Form

Medical History Short Form

New Patient Intake form

Patient Consent Form (COVID-19 screening)

Adobe Acrobat is required if filling in the form and submitting it digitally.
If you don’t have Adobe Acrobat Reader you can download it here.

Office Hours

Monday 7:00 am - 3:00 pm
Tuesday 7:00 am - 3:00 pm
Wednesday 7:00 am - 8:00 pm
Thursday 11:00 am - 8:00 pm
Friday 8:00 am - 4:00 pm
Saturday* 8:00 am - 4:00 pm
Sunday Closed

* Alternating weeks open

Our Address

Dr. John VandenBrink

Tel: (780) 452-5700

10534 124 St. NW #112
Edmonton, Alberta
T5N 1S1