Referrals | Forest Hill Children's Dentistry in Eglinton

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Please complete the form below*. To share additional patient files, please call our office for more information.

Patient Information

Patient's First Name

Patient's Last Name

Date of Birth

City

Phone Number

Dentist Information

First Name

Last Name

Email Address

Your email address will be used to send you a confirmation of receipt and/or consultation report.

Phone Number

What service are you referring the patient for?

Additional Information

Provide additional details if possible.

Upload X-rays & Other Images

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If sending multiple files, please combine them into a ZIP file before uploading.

When were these images taken?

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*IMPORTANT: Any form submitted by email must be encrypted, to ensure it is secure. By submitting an unencrypted email form, you are consenting to an unsecured email. Alternatively, please call our office to refer a patient.

Refer a Patient to Our Eglinton Dental Office

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Patient Information

Dentist Information

Additional Information

Upload X-rays & Other Images

Helping patients achieve their best smiles.

Phone

Fax