Patient Referral

Refer a Patient to Lynn Valley Orthodontics

We’re pleased to partner with dentists and healthcare professionals to provide specialized orthodontic care for your patients.
Please complete the referral form below and include any relevant clinical information, X-rays, photographs, or other supporting records that may assist our orthodontic team in assessing the patient’s needs. 

Patient Referal PDF

Once we receive the referral, our team will review the information and contact the patient or family to arrange an appropriate orthodontic consultation.
Thank you for trusting Lynn Valley Orthodontics with your patients’ orthodontic care.

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Patient Name*
Parent / Guardian Name

Primary Insurance

Secondary Insurance

Concerns

Concerns