Note: When the form is complete, please email it to
To fill out an electronic PDF referral form please click the BLUE rectangle.
Please note, on mobile, it might be difficult to download and
Referring Dentists and Staff members
We do thank you for all your referrals & your support.
For the convenience of your patients, we offer “consultation and dental treatment under general anesthesia on the same day”; with a medical pre-op.
We can accommodate urgent cases for treatment under general anesthesia at your request.
The general anesthesia is performed by certified anesthesiologists at a certified Surgical Centre.
To fill out an electronic PDF referral form please click the rectangle.
We also accept referrals by email, fax or phone...
Phone: (780) 484-5667
Fax (780) 484-5681