Dentist Referral

We’re Here to Provide Child-Friendly Dental Care

Thank you for considering Children’s Dental Healthcare for your patient referrals. Dr. A has hospital privileges at Joe Brant and McMaster Children’s Hospitals and the ability to offer general anesthesia in our office, enabling us to provide specialized, comfortable care for children with a wide range of dental needs. We value the partnership we share with fellow dentists in supporting healthy smiles for kids.

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Patient’s First Name*

Patient’s Last Name*

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Phone*

Parent/Guardian Email

Referring Dental Office Name*

Referring Dentist Name*

Referring Dentist Phone*

Referring Dentist Email*

Reason for Referral

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Burlington Pediatric Dental Services

Kid-Friendly Environment

Hospitals where we support children’s oral health

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