We would be pleased to assist you in creating a beautiful healthy smile that’s perfect for you. Please fill in all applicable fields in the form below, and someone from our team will get in touch with you as quickly as possible.

* indicates a required field
* Title: Choose one... Mr. Ms. Mrs.
* First Name:
* Last Name:
Gender:
Company:
Address:
City:
Province/State:
Postal/Zip Code:
Country:
* Email:
Telephone (Home):
Telephone (Work):
Telephone (Cell):
Fax:
Preferred time and method for us to contact you:
How did you find our website? If internet search was used, please list search engine (i.e. Google) and keywords:
Please list your dental concerns and smile services of interest:
Additional Comments:

Dr. Bruno Paliani

251 Fanshawe Park Rd. W.

London, ON N6G 0E1 CANADA

Tel: 519-434-2331

Fax: 519-434-7131

Toll Free: 1-877-i-SMiLE-2 (1-877-476-4532)

E-mail Address: newsmile@smiledentist.com

Click the images and logos for directions to our office.