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Proactive & Holistic Dentistry
Dental Hygiene & Teeth Cleanings
Proactive Dentistry
Full Mouth Rehabilitation
General Dentistry
Sedation Dentistry
Emergency Dentistry
Pediatric Dentistry
Restorative Dentistry
Cosmetic Dentistry
No Prep Veneers
Teeth Whitening
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Clear Aligners
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Virtual Consult
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Kindly fill out the form below, so that we may understand your needs a bit more. You will be asked to take some photos, which are uploaded securely.
Name
*
Email
*
Phone
Please tell Dr. Nicole about your history and your goals.
What bothers you most about your smile?
Colour
Length
Shape
Spacing (crowding or gaps)
Health (chips, cracks, decay, etc.)
Other
How long have you felt this way?
As long as I can remember
A few years
Recently
Do you ever hide your smile in public or photos?
Yes
No
What’s holding you back from fixing your smile?
Cost
Fear of the dentist
Time commitment
Nothing, I’m ready!
Full Face
*
Upload a file
or drag and drop.
jpg, jpeg, jpe up to 10MB
Normal Smile Left
*
Upload a file
or drag and drop.
jpg, jpeg, jpe up to 10MB
Normal Smile Centre
*
Upload a file
or drag and drop.
jpg, jpeg, jpe up to 10MB
Normal Smile Right
*
Upload a file
or drag and drop.
jpg, jpeg, jpe up to 10MB
Open Smile Left
*
Upload a file
or drag and drop.
jpg, jpeg, jpe up to 10MB
Open Smile Centre
*
Upload a file
or drag and drop.
jpg, jpeg, jpe up to 10MB
Open Smile Right
*
Upload a file
or drag and drop.
jpg, jpeg, jpe up to 10MB
Our team will be in touch within a couple of business days to confirm whether you would like to book a live virtual consultation with Dr. Nicole, receive a personalized video from her outlining your potential treatment options, or schedule an in-person consultation.
I consent to Vigée Dental staff and doctors reviewing my personal health information and contacting me by email or phone.
Yes
No
Closed Mouth Example
Open Mouth Example
Request a Booking
Please fill out the form below and we will get back to you as soon as we can.
First Name
*
Last Name
*
Phone Number
*
Email
*
Service
New Patient Exam
Dental Hygiene (Cleaning)
Emergency Dentistry
Service
Veneers
Botox
Clear Aligners
Date Requested
