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Princess Elizabeth Dental
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Patient Registration

New patients may preregister with our office by filling out our secure online Patient Registration Form.  After you have completed the form, please make sure to press the "Submit" button at the bottom to automatically send us your information.  On your first visit to our office, we will have your completed form available for your signature.



Patient Registration Form



*Note that the security and privacy of your personal data is one of our primary concerns and we take every precaution to protect it.  Your registration information comes to us by encrypted download from a secure third-party server.   



Call us today to book an appointment!


CONTACT USorCALL 780-488-0383




Princess Elizabeth Dental

10515 Princess Elizabeth Ave
Edmonton, AB T5G 0Y5
Tel: 780-488-0383
Fax: 780-488-7745




Edmonton Dentists


Dr. Bill Holden

Dr. Ali Afshar

Dr. Sara Afshar

Dr. Shouresh Charkhandeh



Dental implants and general dentistry in Edmonton and area.

Please call our office with any questions or to make an appointment.

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