Log In to eReferral
Print Referral Form
Print Referral Pad
Case Difficulty Assessment
Treatment Options Guide
To assist you in booking appointments for your patients as quickly as possible, the referring Dentist should send a comprehensive written report. The report should include:
1. Patient’s name and contact information (date of birth, address and phone numbers).
2. Referring dentist’s name and contact information.
3. Reason for referral.
4. Relevant history. Indicate any special factors, either dental or medical. Include any dental treatment history which may apply to the area of concern.
5. Current periapical radiographs (x-rays). These need to be taken before and after any treatment done by the referring dentist. Include any historical radiographs of the area which may help in diagnosis.
If requesting treatment to start on the first appointment, the patient needs to complete one of our medical history forms and fax or mail it to our office. Our Endodontist will review the information and we will contact your patient to schedule the appropriate type of appointment. Please be advised that a separate examination appointment may still be necessary prior to booking treatment.