Refer a Patient | TheSmileDoc

We work closely with your patient and with you, their treating dentist or denturologist, to provide high quality care. Depending on your preference, we take care of part or all of the treatment. At your request, we also offer you support and advice for the care of the patients you refer to us.

We want to offer all our patients and their referring dentists or denturologists a positive experience at all stages of treatment.

To Refer a Patient, please complete the form below and we will contact you very shortly.

All fields identified by an asterisk ( *) are mandatory.

Patient's first name

Patient name

Patient's phone

Date of birth

Referred by

Dentist

Denturologist

Doctor

Other

Referrer's name

Referrer's email

Please contact me by phone following the initial consultation.

Referrer's phone

License number

Care required

Implant surgery only, then refer the patient to the referring dentist/denturologist for restoration.

Implant surgery and restoration, then redirect the patient to the referring dentist/denturologist.

Explanation of the different prosthodontic options to the patient, perform the treatment chosen by the patient then redirect him to the referring dentist/denturologist.

Consultation only and report to the referring dentist/denturologist.

Additional information

Imagery

Upload your images Upload your images

Please send us the x-rays on file. Possibility to add 3 images. Formats jpg, pdf, txt, 10 megabytes maximum each. If you are not digital, you can take a photo of your x-ray with a smart phone and email it to us at direction@thesmiledoc.com