Professional Referrals

Referring to True North Orthodontics is an easy process. We are committed to your patients and promise they remain in the best care at our office.

Patient Referral Form

To refer your patient to True North Orthodontics, please complete the form below and we will be in touch.

Referring Doctor: *

Email of Referring Doctor: *

Phone Number of Referring Doctor: *

Patient's Name: *

Parent's Name (if required):

Parent's Phone Number (if required):

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Appointment Information: *

Appointment has been scheduled. Call patient to book appointment.

Treatment Recall: *

Refer back following completion of treatment. Patient to continue recall care in your office.

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