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Referring Dentists

 

 

Your smile is as unique as you are.

At the clinic of Ottawa Periodontists, we’re incredibly proud to be a part of the dental and periodontist community here in Ottawa. We believe in providing the best care and service to our patients – whether at our clinic or one of our colleagues. We also appreciate any referrals we receive to our practice.

If your clinic or practice is interested in referring a patient to us simply fill out the form below.

You can then either fill out the referral form and send it to our office or contact us directly via phone or email. If you have any relevant X-rays that you would like to send, we’d be happy to receive them by email or standard mail.

Our office also participates in the Secure Send program and Brightsquid which allows dentists and specialists to communicate with one another on specific patient cases. This program is offered by the CDA to all member dentists and can be accessed by logging on to the CDA website.

Thank you in advance for your referral and we look forward to helping your patients!

"*" indicates required fields

PATIENT INFORMATION

MM slash DD slash YYYY
Patient prefers to speak*
OR
Please call patient to schedule appointment
Do You Have Radiographs or Documents to Upload?*

RERERRAL INFORMATION

Requested Surgeon:

Treatment Considerations

Type
Please indicate implant system of preference for the restorative dentist:

Teeth or Area to be Treated

teeth
Comprehensive Periodontal Exam. The patient had:
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.

Smile with Confidence

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