Refer a Patient to Our Toronto Dental Office

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

Please download our PDF referral form and email or fax it to Forest Hill Children's Dentistry.

Patient's First Name

Patient's Last Name

Patient Phone Number

Patient Email

Date of Birth

Patient's Home City

Responsible Party

Practice Name

Practice Email Address

Phone Number

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

Doctor First Name

Doctor Last Name

What services are you referring the patient for?

Consultation Only (Explain in space below.)

Provide Necessary Treatment

Provide Specific Treatment (Explain in space below).

Provide additional details if possible.

Current Radiographs: Please check one.

None Obtained

Attached

Emailed Seperately

When were X-rays taken?

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

Attach X-rays

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New Patients Always Welcome

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