416-483-0000

Looking To Refer A Patient To Our Office?

Thank you for the confidence you have placed in our care. We look forward to providing your patient with excellent care and service!

Name of Referring Doctor

Phone Number

Email Address

Practice Name or Location

Which location are you referring to?

Vaughan (Dufferin and Major Mackenzie Dr W- Formerly Vaughan Children's Dentistry)

North York (Bathurst and Sheppard)

Either Location

Is there a request for a specific dentist to see this patient?

Any dentist / First Available

Dr. Sean Ostro

Dr. Carly Greene

Dr. Nicole Lastman

Dr. Kimberly Ngai

Dr. Jeremy Goldberg

Dr. Heather Ford (Orthodontics)

Patient Information

Name of Patient

Name of Parent(s) / Guardian(s)

Patient's Phone Number

Patient's e-mail

Please provide:

Complete Care including Hygiene

Specific Treatment

Lip / Tongue Tie

Treatment with Sedation / General Anesthesia

Orthodontic Consultation

Please list any specific concerns for this patient, or any teeth/areas that require treatment

Radiographs

None taken

E-mailed to vaughan@britebite.ca

Uploaded below

Mailed

Sent with Patient

Upload X-Rays

Following Treatment

Following treatment, a completion letter will be sent by CDA Send Secure

Following treatment, please

Refer the patient back for hygiene/routine care

Continue to see the patient for hygiene/routine care

Ask the patient which they prefer