Referring Patients To Hilltop Dentistry

Hilltop Dentistry offers many specialized services to save patients time and travel. We do accept referrals from other dental offices in our area to help other colleagues to provide the best treatment options and outcome to their valued patients. Please complete the form below for online referrals.

We accept referrals for CBCT, Endodontics treatment, Sedation Dentistry, Surgical treatment including impacted wisdom teeth removal and all Periodontal treatment including soft and hard tissue grafting and implant surgery in our office .

Please send any relevant radiographs including Panoramic radiographs directly to our email info@hilltopdentistry.ca

Referral Form

Referring Doctor Name

Referring Doctor Office Name

Referring Doctor Phone Number

Referring Doctor Email

Patient First Name

Patient Last Name

Patient Date Of Birth

Patient Full Address

Patient Phone Number

Insurance Carrier

Insurance Policy Number

Insurance Certificate Number

Insurance Policy Holder Name

Insurance Policy Holder Date of Birth

Reason For Referral

Region Of Interest for CBCT

Referral Details like tooth number, clinical information etc

5 + 10 =