Dr Éric Fortier

Are you a dentist?

Refer your patients to us with confidence, we are committed to treating them with the same dedication and professionalism that you yourself demand. Fill out the form below to send us a referral.

1 Referring dentist

First name *

Last name *

Email *

Phone *

2 Patient

First name *

Last name *

Gender * MF

Date of birth *

Email (optional)

Phone *

3 Clinical information

X-rays (optional)

Upload the panoramic radiograph. Accepted formats: jpg, pdf, png.

Accepted formats: jpg, pdf, png.

Upload

4 Communication

Appointment scheduling *

Comments (optional)

5 Confirmation

The patient consents to the sharing of their personal information. *

By checking this box, the patient consents to the sharing of personal information, including their first name, last name, email, phone number, date of birth, and dental x-rays, with the designated orthodontist for the purpose of conducting an orthodontic evaluation. It is important to note that the patient has the right to revoke this consent at any time in writing, although such revocation may impact the continuity of care.

A consultation report will be sent to you following your patient's visit. If you have any additional questions, please do not hesitate to contact us.

You will receive a confirmation upon receipt of the form.

We would like to thank you for your trust!

Any questions?

Feel free to contact us! Our team is here for you, always ready to meet your needs, listen to your concerns, and assist you in the most professional and efficient manner possible.

819 595-8966

Send us a message

Refer a patient

Are you a dentist?

1 Referring dentist

2 Patient

3 Clinical information

4 Communication

5 Confirmation

Any questions?

Are you a dentist?

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