ORTHODONTIST AT AGORA
819-595-4555
 
Make an appointment
Refer a patient

Form | Refer a patient

Form for dentists.

    Patient information:

    Please call patientPatient will call

    Reason for referral:
    CrowdingExcess spaceMissing teethImpacted teethCrossbiteOral habitsOverjetClass IIClasse IIIOverbitePre-prosthodontic orthoOrthognathic surgery

    Radiographs:

    Imaging (radiographs, photos) | Formats .jpg, .pdf, .txt:

    Date of radiograph:

    Name of referring dentist:

    Email of referring dentist:

    Additional information:

    Infos

    If you have any questions about our clinic, please contact us and we will be happy to assist you.

    10 Allée de Hambourg, Suite 305B Gatineau (Québec) J9J 4K1
    819-595-4555
    [email protected]
    Opening Hours
    Monday
    7:30 AM – 4:30 PM
    Tuesday
    7:30 AM – 4:30 PM
    Wednesday
    7:30 AM – 4:30 PM
    Thursday
    7:30 AM – 4:30 PM
    Friday
    7:30 AM – 4:30 PM
    Saturday - Sunday
    Closed
    Website Overview
    Make an appointment
    Refer a patient
    https://orthoduplateau.com/wp-content/uploads/2022/08/Orthoduplateau_variation1-160x160.png

    All rights reserved © 2022

    https://orthoduplateau.com/wp-content/uploads/2022/08/Orthoduplateau_variation1-160x160.png

    All rights reserved © 2022