Specialty dental care delivered with precision, collaboration, and patient focus.

Referring Dental Online Form

Advanced Specialty Care. Seamlessly Delivered.

Focused expertise for complex dental needs — provided in collaboration with our dental community and centered on patient well-being.
Thank you for entrusting Dundurn Dental Specialty with your patient’s care. We are committed to providing specialist assessment and treatment within the scope of your referral.
Our team will review the clinical information provided, contact your patient to arrange consultation, and maintain clear communication throughout the treatment process. A detailed report will be forwarded to your office, and your patient will be returned to your care once specialty services are complete.
If there are specific clinical considerations, timelines, or preferences you would like us to note, please include them below.

Dental Referral Online Form

Referring Dentist Information

Preferred method of communication:

Patient Information

Has the patient been informed of this referral?

Reason for Referral

Has the patient been informed of this referral?

Clinical Concern / Diagnosis (Brief description of the presenting issue)

Treatment Requested
Max. file size: 50 MB.

Relevant Clinical Information

Information