Refer a Patient

Thank you for your confidence in referring patients to myORTHODONTIST. We look forward to collaborating with you – and taking exceptional care of them. Please complete the form below or call our office to get started.

All Referrals Welcome

We know you have a choice when referring your patient to an orthodontist. We thank you for considering myORTHODONTIST.

Whether your patient is a child who can benefit from early intervention, a teen who needs braces or Invisalign or an adult who may be having airway issues or simply wants a straighter smile, our team is committed to continuing the quality of care you've started.

We want you to know that we take the matter of your trust as our responsibility.

Refer by Phone

Click on a link below to reach the myORTHODONTIST nearest you.

Referral by Email

Please provide us with as much information as possible. We'll be in touch with your patient or parent/guardian to follow up. Thank you!

Referring Practice Information

Doctor Name (First and Last) *

Practice Name *

Email *

myORTHO Location

Select *

myORTHO Westwinds (North Calgary) myORTHO Mckenzie Towne (SE Calgary) myORTHO Aspen Landing (SW Calgary)

Referral Information

Patient First Name *

Patient Last Name *

Is the patient a child? *

Yes No

Parent or Guardian Name (If relevant)

Relationship to Child (If relevant)

Parent Grandparent Guardian Other, please provide details in Comments below

Patient or Guardian Phone Number *

Patient or Guardian Email Address

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