220 North Service Road West, Oakville, ON

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ReferralsRefer a Patient to Oakville Orthodontics

We value the relationships we have built with dentists and other healthcare professionals throughout Oakville and surrounding communities.

Our online referral form provides a convenient way to submit patient information and request an orthodontic assessment. Once received, our team will review the referral, contact the patient or guardian as appropriate and coordinate the next steps in care.

Submit a Patient Referral
The Oakville Orthodontics team outside the office

Dentist Referral Form

Submit a Patient Referral

Please complete the form below with the referring office and patient information. Include relevant clinical details and the primary reason an orthodontic assessment is being requested.

Need Help With a Referral?

Contact Oakville Orthodontics if you would like to discuss a patient before submitting the form or need assistance providing supporting records.

Phone905.845.8411 Emailinfo@oakvillebraces.com
Contact Our Office

1Practice Information

Please enter the referring doctor’s name.
Please enter the practice name.
Please enter a valid email address.

2Referral Information

Please enter the patient’s name.
Please select the patient’s age group.
Please enter a contact person.
Please enter a valid email address.
We would appreciate any recent images / x-rays for the patient. Please add attachment.

One of our patient care coordinators will contact you within the next business day.

Thank you!

One of our patient care coordinators will contact you within the next business day.