Referral Forms

For your convenience we have several different methods for accepting referrals to our office. Choose the method that best suits your needs.The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it. If you would like to request a paper referral booklet, please call our office at Lethbridge Office Phone Number 587-425-1600 and we will send you a booklet by mail.


OPTION 1: To refer a patient to us directly online, please click the Online Referral Form button below. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. You will be able to attach digital radiographs to the referral.


OPTION 2: Click here if you want to print a blank referral form to fill out by hand.

You can mail it to our office or fax it to our Treatment Coordinator at 587-425-1601.


OPTION 3: Click here to access the secure eRefferal Pilot program.

This is a free online service endorsed by the Canadian Dental Association to help dentists collaborate with their referring doctors in a secure format compliant with PIPEDA & RCDSO guidelines. If you have not joined eReferral Pilot, you can sign up in a few easy steps. You will then have access to two-way communication with the office regarding your patient, as well as the ability to upload any radiographs, pictures, or files. We can also send files, radiographs, and images to you through the eReferral Pilot program if necessary.