We accept the
Canadian Dental Care Plan (CDCP)
at both our locations.
Learn More.
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Contact
Contact
Call Sunridge
Call Southport
Request Appointment
Careers
Home
About
About
Meet The Team
Gallery
New Patients
New Patient Form
Canadian Dental Care Plan (CDCP)
Financing
Orthodontics
About the Orthodontist
Orthodontic Services
Patient Information
Emergency Care
Referring Doctors
Resources
Blog
FAQ
Videos
Contact
Contact
Call Sunridge
Call Southport
Request Appointment
Careers
Referring Doctors
We greatly value your Professional Referrals.
Location Preference
*
Southport Office
Sunridge Office
Referring Doctors Name
*
First
Last
Referring Doctors Contact Number
*
Referring Doctor Contact Email
*
Parents Name
*
First
Last
Parents Contact Number
*
Parents Contact Email
*
Patient #1 Name
*
First
Last
Patient #1 Date of Birth
*
MM slash DD slash YYYY
Reason for Referral
*
General Anesthetic
Routine Care
Orthodontic Treatment
Other
Have radiographs been taken?
*
Yes
No
Please provide any pertinent information regarding the patient’s dental or medical history.
Patient #2 Name
First
Last
Patient #2 Date of Birth
MM slash DD slash YYYY
Reason for Referral
General Anesthetic
Routine Care
Orthodontic Treatment
Other
Please provide any pertinent information regarding the patient’s dental or medical history.
Doctor Preference (Please Choose One)
*
Dr. Farida Saher
Dr. Leonard Smith
Dr. Celeste Williams
Dr. Sabrina Sunderji
Dr. Phoebe Good
No Preference
Your Message (Optional)
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