Referral Implants • Stouffville SMILES Dentistry

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LCBO Plaza - Stouffville
905-591-5599
reception@stouffvillesmiles.ca
MON 10-6pm TUE 10-7pm WED 10-8p THU 10-7pm FRI SAT 8-2pm

CHILDRENIMPLANTSSEDATIONORTHODONTICSFAMILY

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About Us
Services
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Refer a Patient
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Schedule Now! 905-591-5599 Email

MON 10-6pm

TUE 10-7pm

WED 10-8pm

THU 10-7pm

FRI SAT 8-2pm

Dental Implants

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Clinician Information

Dentist's Name*

Office's Name*

Office's E-mail*

Office's Phone*

Patient Information

First Name*

Last Name*

Date of Birth*

E-mail

Phone*

Referral Details

Referral Notes*

Adjunctive Procedures(s)

Extraction
Bone Grafting
Dental Implant(s)
Temporary Crowns/Bridges
Temporary Denture / Flipper / Essix
Final Crown/Bridge
Final Implant Supported Denture

Area of Interest

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Family, Cosmetic, Sleep and Implant Dental Clinic in 5710 Main Street Unit #3, Stouffville, Ontario, L4A8A9 serving residents of Stouffville, Ballantrae, Musselman's Lake, Goodwood, Claremont, Uxbridge, Markham, Richmond Hill and the Greater Toronto Area.

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