Professional Referrals

Richmond Hill Oral Surgery welcomes referrals from other dentists, doctors, and medical professionals. We look forward to working with you to care for your patient.

Thank you for considering the Richmond Hill Oral Surgery team for your referral.

You can rest assured that we will provide your patient with the highest quality of care.

Please complete the form to the right and a member of our team will be in touch shortly.

» Download Referral Card PDF

Please download and fill out this PDF, and attach it when you submit your referral form. Or, you can submit it by fax or email, here.

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Please Complete This Referral Form:

Referring Doctor's Name: *

Referring Doctor's Phone Number: *

Referring Doctor's Email Address: *

Referring Doctor's Request: *

Please contact me about this patient.

Please contact the patient (or the patients parent-guardian) directly.

Please be aware that I have asked the patient to contact Richmond Hill Oral Surgery.

Other

Patient's First Name: *

Patient's Last Name: *

Patient's Age: *

Parent or Guardian Name (for patients under 18):

Patient Phone Number: *

Patient Email Address:

Upload File Attachment:

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Notes/ Comments:

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