Quiz

Please answer the following questions and Submit to us. If you answer all the questions correctly, your submission will be placed for a draw of a $100 store/restaurant Gift Certificate of your choice. (for our clients or Brant County residents only). Draw ends at every quarterly year. Thank you for participating!

1.	Who is our newest dentist at West Street Dental Group? (Hint: see page About Us - Dentists)
2.	What is the mission statement of West Street Dental Group? (Hint: see page Philosophy - Our Mission)
3.	What are the People Hours (office hours) of our Office? (Hint: see page Location - Hours)		Mon. - Fri. Sat.
4.	List 3 signs of gum (periodontal) diseases?	1:
	(Hint: see page Services - Gum Treatments)	2:
		3:
5.	What is West Street Dental's e-mail address? (Hint: see page Contact Us)

Please provide the following contact information:

*These fields are required

*First Name

*Last Name

Title

Address

City

Prov/State

Postal/Zip Code

Work Phone

*Home Phone

FAX

*E-mail

Are you a patient of West Street Dental Group?

Yes No

Use the space below for your Questions & Comments: