(403) 225-1991
Book Now
(403) 225-1991
Why Choose Us
Dental Fees
Dental Insurance
FAQs
Health & Safety
Canyon and the Community
Services
Family Dentistry
Children’s Dentistry
Emergency Dentistry
Dental Hygiene & Teeth Cleanings
Root Canal Therapy
Orthodontics
Invisalign
6 Month Smiles
TMJ/TMD Therapy
Cosmetic Dentistry
Zoom Teeth Whitening
Porcelain Veneers
Cosmetic Tooth Bonding
Botox®
Restorative Dentistry
Dental Crowns
Dental Bridges
White Fillings
Oral Surgery
Tooth Extractions
Dental Implants
Wisdom Teeth Extractions
New Patients
New Patient Form
Team
Meet the Dentists
Dental Hygienists Team
Dental Assistant Team
Administration Team
Appointments
Education
Products
Contact
Book Now
Zoom Whitening Questionnaire
Name
(Required)
First
Last
Cell Phone
(Required)
Email
(Required)
Are you over the age of 12?
(Required)
Yes
No
You will need to wait until you’re a little older before whitening your teeth.
Are you currently pregnant or breastfeeding?
(Required)
Yes
No
You must wait until you are no longer pregnant or breastfeeding before you can whiten your teeth.
Do you have a compromised immune system or are you undergoing treatment for a serious medical condition?
(Required)
Yes
No
We will need to consult with your doctor prior to ZOOM! whitening.
Have you had a dental examination in the last 6 months?
(Required)
Yes
No
You will need a complete dental exam and x-rays to rule out any active disease in your mouth.
Are you currently undergoing any treatment for your gums (periodontal treatment)?
(Required)
Yes
No
Treatment will need to be completed prior to ZOOM! whitening.
Are you aware of any existing cavities or chipped/broken fillings in your mouth?
(Required)
Yes
No
The restorations will need to be completed prior to ZOOM! whitening.
Do you have any fillings/crowns/veneers on your front teeth?
(Required)
Yes
No
Any restorations on teeth will not whiten with ZOOM!.
Are your teeth sensitive?
(Required)
Yes
No
ZOOM! may not be right for you but you still may be a candidate for at-home whitening.
You are an excellent candidate for ZOOM! whitening. The office charge is $375 which includes your in-office whitening as well as custom trays to touch up your smile for years to come! We require 2 appointments to brighten your smile – the first is a 15 minute appointment to take molds of your teeth and the second is a 1.5 hour appointment to complete your in-office ZOOM! whitening. Please click "Send" underneath to request your Zoom Whitening appointment.
Phone
This field is for validation purposes and should be left unchanged.
48900
From all of us at Canyon Dental Centre, we look forward to seeing you soon.
We look forward to hearing from you soon!
Call us at
(403) 225-1991
to book an appointment!
Book Online Today
Call Now
Why Choose Us
Dental Fees
Dental Insurance
FAQs
Health & Safety
Canyon and the Community
Services
Family Dentistry
Children’s Dentistry
Emergency Dentistry
Dental Hygiene & Teeth Cleanings
Root Canal Therapy
Orthodontics
Invisalign
6 Month Smiles
TMJ/TMD Therapy
Cosmetic Dentistry
Zoom Teeth Whitening
Porcelain Veneers
Cosmetic Tooth Bonding
Botox®
Restorative Dentistry
Dental Crowns
Dental Bridges
White Fillings
Oral Surgery
Tooth Extractions
Dental Implants
Wisdom Teeth Extractions
New Patients
New Patient Form
Team
Meet the Dentists
Dental Hygienists Team
Dental Assistant Team
Administration Team
Appointments
Education
Products
Contact
×
