Refer A Patient

Service from the heart is what we’re known for. A dependable, successful pediatric practice doesn’t come out of thin air, it’s the result of professional relationships of colleagues and patients that surround us.

Thank you for You Trusting Us

We have been specializing in pediatric dentistry for over decades and look forward to continuing our tradition of great service into the future. 

The trust you’ve placed in us to give your patients the care they need is incredible and we appreciate your recommendations to PDG. We are so honoured to have your support as we continue to build our practice. You can referral a patient by downloading the PDG Form and sending it by email or filling the digital form below.

PDF Form

You can download PDF version of the Referral Form.

Online Referral form

Click on the button below if you want to refer a patient to PDG:

Thank you for You Trusting Us

We have been specializing in pediatric dentistry for over 40 years and look forward to continuing our tradition of great service into the future. 

The trust you’ve placed in us to give your patients the care they need is incredible and we appreciate your recommendations to PDG. We are so honoured to have your support as we continue to build our practice.

Online Referral form

    Referral Form

    Patient referral by:

    Patient Information

    Name*

    Age Category

    Phone* (to contact the patient with appointment information)

    Is the patient aware of this referral?*

    Refer patient to this PDG location:

    Describe reason for referral

    Patient Information

    Name*

    Date Of Birth*

    Address*

    Phone*

    Guardian's Name

    Email

    Refer patient to this PDG location:

    Referring Doctor Information

    Referring Doctor*

    Practice Name*

    Office Address*

    Office Phone*

    Email*

    Patient referral to:

    Notes

    Please forward Radiograph prior to appointment

    Notes

    Please forward Radiograph prior to appointment

    PDF Form

    You can download PDF version of the Referral Form.

    This is for Medical/Dental Professionals only

    If you are a parent, please phone our office for assistance.

    referRAL TO OUR

    Pediatric Dental Specialists

    REFERRAL TO OUR​

    Orthodontic
    Specialists

    Request a Free Consultation

    Our Certified Specialists in Orthodontics will help you determine which treatment option is right for you.

    Request an Appointment

    CALL US NOW 604-PDG-1000 OR FILL OUT THE FORM BELOW TO REQUEST AN APPOINTMENT