Request a Complimentary Consultation

To schedule a complimentary consultation with Dr. Shapiro, please call our office at 905 731 9699, or complete as much of the information below as possible and one of our staff will call you back. Knowing how valuable your time is, filling in the fields below will allow us to prepare your file before we call you back so we can save you time on the phone. We look forward to meeting you soon!

Patient first and last name (required)

Patient date of birth (required)

Mailing Address

City

Postal code

Family dentist

Is there anyone we can thank for referring you to our office?

Home Telephone Number (required)

Work Telephone Number

Mobile Telephone Number

Your Email (required)
This is used only for appointment reminders

For Minors

Mother's full first and last name:

Father's full first and last name:

If legal guardian, full first and last name:

Please tell us what is the best way to reach you?

Comments / Message:

Please click SUBMIT and a member of Dr. Shapiro's team will contact you by the end of the next business day. We look forward to meeting you soon.