Doctor Referral

Thank you for showing your confidence in our practice by recommending us to your patients. Please fill out the referral form below.

A successful practice doesn’t just happen. It is the result of a strong commitment to excellence in our treatment and in our relationships with patients and other doctors. We’d like to take a moment to thank you for showing your confidence in our practice by recommending us to your patients. We’re gratified to learn that many new patients call us based on your words of advice!

Please Select an Office and Preferred Doctor

Mission Creek Orthodontics
Kelowna Orthodontics
West Kelowna Orthodontics

Please fill out the following information about your patient

Patient Name(Required)
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Is there any dental work outstanding?
Have any panoramic or cephalometric radiographs been taken in the past 3 years? (If yes, please forward to our office and indicate the date they were taken)
Please call dentist BEFORE / AFTER examination
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