Dentist Referral

If you are a physician or dentist referring your patient to us for orthodontic specialty care, please complete the below form and we’ll follow up directly with your patient.

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218 Commissioner's Rd. W • London, Ontario N6J 1Y1
291 Talbot Street, St. Thomas, Ontario N5P 1B5
Phone: 519-685-3060 • Fax: 519-685-7034 •