Request Appointment with Fourth Ave Endodontics

Request CBCT Appointment Form

Download our CBCT referral form if you'd prefer to bring it in.

01Patient Information

First Name

Last Name

Telephone Number

Please enter a valid telephone number.

Date of Birth

Please enter a valid date of birth.

Referring Doctor

Referring Doctor Name

Referring Doctor Telephone

02CBCT Information

Type of CT Scan Requested

Please enter a valid type of ct scan requested.

Area of Interest

Please enter a valid area of interest.

Please provide any recent radiographs or other images taken of the patient in the area of clinical interest.

03Additional Remarks

_{* Appointment time is reserved for you. Please be aware that 48 hour notice is
required to reschedule your appointment to avoid a cancellation fee. All appointments must be
confirmed.}

Address

Suite 237 - 1338 Fourth Ave, St. Catharines

Phone

Tel: (289) 362 - 2980

Fax: (289) 362 - 3382

E-mail

info@fourthaveendodontics.com

Hours

Monday - Friday: 8am - 5pm

Payment Options

Your consultation appointment will provide you with a predetermination outlining the costs of your upcoming treatment. Payment will be due at the time service is rendered. We accept Visa, Mastercard, Debit, American Express or cash payments. If you have insurance coverage, we can assist you in submitting your claim electronically or provide you with the forms necessary for you to submit independently.

Request CBCT Appointment