survey forms

Personal Appointments

To request an appointment online, please fill out the form below to begin your "New Patient Experience" with our office. Click the "Send" button to send the request to one of our treatment consultants. Thank you!

*Required.

Steven J. Deneka, B.SC., D.D.S

Name*

Phone Number (please include area code)*

E-Mail Address*

Preferred day of the week

MON TUE WED THU FRI

Preferred time of day

a.m. p.m.

How did you hear about us?

Please review the information you are about to submit for accuracy. Thank you.

 

Home | About Us | Patient Services | Photo Gallery | FAQs | Favorite Links
Patient Library | Practice News | Ask The Doctor | Contact Us

806 Pitt Street • Cornwall, Ont. K6J3S2 • Phone 613-932-2058 • Fax 613-932-6923

©2003 Steven J. Deneka, B. SC., D.D.S.
Site designed and maintained by TNT Dental