Denture Patient Referral – Northern Lights Denture Clinic

Trusted denture care in Prince George since 2011

Trusted Patient Care

Denture Patient Referral

For A Closer Look, Second Opinion, Or For A Case Too Complicated, You Can Trust Our Denture Clinic With Your Patients And Their Needs

Referral Form

Refer Your Patient with Confidence

01Referring Practice Information

Referring Dentist

Name of Referring Practice

Practice Phone Number

Practice Email

02Patient Information

Patient Name

Patient Phone Number

Patient Email

Patient D.O.B

Date of Last Exam?

Assistance Required?

Patient Records

Additional Comments/ Reason For Referral

Contact Our Clinic

We’re ready to support
your patient.

Call our clinic on (250) 562-2620 if you would like to discuss a referral.

Our office is located at 701 Victoria St, Prince George, BC, V2L 2K5.