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The growth of our practice depends, among other things, on references from our patients and professional colleagues. Please do no hesitate to refer to our practice your family and friends if you are satisfied with our services. If you know someone needing orthodontic care who would like to have an orthodontic evaluation, you can give us their coordinates so that we communicate with them to offer them a consutation.
Refered by: your first name – your last name
Your phone #: – Your email
You are referring: Patient’s first name – Patient’s last name
Patient’s phone #: – Patient’s email
Comments:
If you are the referring dentist: Radiographs sent? Yes – No
Date sent : DD MM YY
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