top of page

DOCTOR REFERRAL

Laney P. – Actual Fort McMurray Orthodontics Patient

FILL OUT OUR DOCTOR REFERRAL FORM

Would you like to refer one of your patients to Fort McMurray Orthodontics? We are always happy to welcome new patients to our office. Simply fill out the form with your name, the name of your patient, contact information, the patient’s date of birth, the reason for your referral, and any comments. Please upload any pertinent patient x-rays or documents if necessary. If you have any questions or concerns, feel free to contact Fort McMurray Orthodontics.

Hala A. – Actual Fort McMurray Orthodontics Patient

Name*

Patients Name*

Phone Number*

Date of Birth

Address

Reason for Referral

Please upload any pertinent patient x-rays/ documents

Thank you! Your message has been successfully sent. We will contact you very soon!

MEET OUR TEAM

Get to know our orthodontist Dr. Koh and his talented team

bottom of page