Referral Form

Referral Form

We thank our dental and medical colleagues for their trust in our practice. Your patient referrals are always appreciated and most welcome.

Collaborating on Care

Our goal is to coordinate diagnosis, planning and delivery of care with our referring general dentists, dental and medical specialists that may be involved in a patient’s treatment and follow-up care.
If you are a dentist or specialist and wish to obtain more information about our team approach to patient care, you are welcome to call or email us.

"*" indicates required fields

Patient First Name*
Patient Last Name*
MM slash DD slash YYYY
INSURANCE?*
Preferred Dentist*
Dental Services Required*
Doctor Name
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 512 MB.

    Locations

    We’re located in the heart of the University of British Columbia campus and along the Arbutus corridor. We are modern, professional, and specialists in your smile.

    Where to Find Us