Referrals | Hunter Dental in Markham

To refer a patient, please fill out a referral form* below. If you need an immediate appointment, please call our office to talk to our staff and we will try to accommodate your patient.

We are thankful for your referrals and we will refer the patient back to you for future dental needs. A follow-up letter with be sent with details about the success of their treatment. Thank you for trusting us with the care of your patients. - The Hunter Dental Team

(905) 294-3444

Referring Doctor/Dentist

Doctor’s Name: *

Doctor’s Telephone Number: *

Doctor’s Email Address: *

Patient Information

Patient’s First Name: *

Patient’s Last Name: *

Date of Birth (mm/dd/yyyy): *

Address: *

Email Address: *

Cell Phone: *

Home Phone: *

Are there X-Rays available? *

Yes

If yes, please email any X-Rays to contactus@hunterdental.net

Radiographs to Follow *

By Email

Via Post Mail

Reason for Referral *

TMJ

Invisalign

General Dentistry

Other (please explain)

If other, please specify: *

Spam Blocker

*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

Referring Doctor/Dentist

Patient Information

We Accept New Patients