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Select a Reason
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New Patient Exam (New Patients Only)
Regular Checkups & Cleaning (Existing Patients Only)
Specific Exam (Broken Tooth, Pain or Swelling)
Invisalign Smile Assessment (New and Existing Patients)
Consultation (General Treatment Plans, Procedure Requirements, etc)
Patient Availability
(Required)
Monday
Tuesday
Wednesday
Thursday
ASAP (Anytime)
Monday
Morning
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Tuesday
Morning
Afternoon
Wednesday
Morning
Afternoon
Thursday
Morning
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Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Are you booking on behalf of someone else?
(Required)
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Yes
Patient Name
First
Last
Patient Phone
Birth Date
(Required)
MM slash DD slash YYYY
Gender
(Required)
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Consent
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By providing your phone number and email, you agree to receiving electronic communications from Peace Arch Dental or affiliated third-parties. You may opt-out at any time.
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Peace Arch Dental Prime
Get the flexibility of payment plans.
Care for your smile
Peace Arch Dental Payment Plan
Includes 2 full dental cleanings per year
Your oral health essentials, covered.
Get dental exams and x-rays as needed
Stay proactive about your dental care.
Other perks*
Get low interest financing and more.
*Please contact us directly for full details.
Take Control of Your Dental Care
The treatment you want should never be out of reach because you don’t have insurance. And with our in-house payment plans, we're doing out best to make sure it never is.
Choose A Subscription Option
Subscription
*
Option A: $59/month + $100 Initial Fee due upon registration
Option B: $699/year ($100 Initial Fee waived) Credit Card on File Required. 1 Year Commitment
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Setup Fee $100
Setup Fee $100
Patient's Name
*
First Name
Last Name
Phone
*
Email Address
*
Credit Card
Card Details
Cardholder Name
Acknowledgment (Please read carefully)
*
I acknowledge that Peace Arch Dental’s payment plans have been explained to me and that I am electing to commence with a payment plan. I acknowledge that this is a 1-year commitment from the date of sign up and that, if I choose to cancel prior to the completion of the year, I am to pay out the balance in full to Peace Arch Dental. I acknowledge that my payment plan will automatically renew unless I give notice to cancel 1 month prior to the renewal date. I acknowledge that I am responsible for any outstanding payments or payments that are not cleared on credit card.
Total
$ 0.00 CAD
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