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Location | Refer a Friend | Appointment Request Coronavirus Update

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Refer a Friend

A successful practice doesn't just happen. It is the result of a strong commitment to excellence in our treatment and in our relationships with patients and doctors. We'd like to take a moment to thank you for showing your confidence in our practice by recommending us to your friends, family, and colleagues. We're gratified to find how many new patients regularly call on us based on your words of advice.

Choose a form:

• Patient Referral
• Doctor Referral

Doctor Referral Form

If you are a doctor who is referring a patient to us, please fill out and submit the following form.

Your Name:first and last name

Your Practice Name:

Your Email Address:valid email address

Full Name of the Patient You Are Referring:

Radiographs Sent?

Yes No

If yes, when were they sent?mm/dd/yyyy

Comments:

Verification Code:(case sensitive)

Submit

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336 Armour Road | Peterborough, Ontario K9H 1Y6 | 705-743-8085