5010 4TH Ave. Regina, SK (Located in the Rosemont Shopping Centre)

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Appointment Booking Form

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Dental Form

NEW PATIENT FORM

Are you under the age of 18?

Yes

Patient Name

First

Last

Birthdate

Male

Female

Prefer not to say

Address

City

State/Province

Zip/Postal

Phone #

Parent/Guardian (if under 18 years old)

Parent/Guardian Phone # (if different from above):

Are any of your family members (spouse/children/parent, etc) already patients of our office?

Yes

If you're covered under the same dental plan, please list their name

Health Card #

Treaty # (if applicable):

Do you have Dental Insurance?

Yes

Insurance Company Name:

Insured’s Name (if not yourself):

First

Last

Insured’s Birthdate (if not yourself):

Relationship to Insured (if not yourself):

Insured’s Employer:

Group (Plan, Policy or Local) #:

Certificate or ID #:

Secondary Insurance :

How did you hear about Rosemont Dental Clinic?

What is the main purpose of today’s visit?

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Schedule an Appointment Today

Meet Dr. Sungho Jun

Your teeth and fantastic smile are Dr. Jun’s top priorities! But his concern for each patient of Rosemont Dental does not stop there.

Experienced with all forms of dentistry, Dr. Jun is particularly interested in crowns, bridges, and dental surgery. Dr. Jun regularly attends continuing education seminars regarding a wide variety of interests. Dr. Jun is currently an active member of the Canadian Dental Association, the College of Dental Surgeons of Saskatchewan, and the Regina and District Dental Society.

As a family-focused dentist with exemplary professional qualifications, Dr. Jun looks forward to offering the highest quality dental care to patients for many years to come.

Schedule an Appointment Today

Rosemont Dental

Rosemont Dental

Become a New Patient Today!

Appointment Booking Form

NEW PATIENT FORM

Keep in touch

Meet Dr. Sungho Jun

Location

Hours of Operation

Rosemont Dental

Rosemont Dental