For Periodontal Referral Use Only:
Download PDF Periodontal Referral Document
Practices referring Periodontal patients to South Calgary Periodontal Group, please use this form to send your patients information to us. Alternatively, if you do not wish to use the online form submission. Please download the PDF form from the link to the right. If you have any questions about this form, do not hesitate to contact us directly at (403) 278-5446 before submitting the form.
Please fill out the information below as completely as possible.
IMPORTANT: When you click submit, you will receive a successful confirmation message. If you do not see the confirmation message, you will need to check through the form and complete any missing information. A confirmation e-mail will be sent to you confirming the successful submission to the South Calgary Periodontal Team.
*NOTE* If uploading numerous files, this form may take a few minutes to submit.
Please wait till you have the success confirmation message.
Form Submission sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information. Please review our privacy policy and website terms of use prior to submitting your referral request.
At South Calgary Periodontal Group, we are always welcoming new patients.
Call us at (403) 278-5446 to book your consultation appointment today!