Referring Doctors

A successful practice doesn't just happen. It is the result of a strong commitment to excellence in our treatment and in our relationships with patients and other doctors. We'd like to thank you for showing your confidence in our practice by recommending us to your patients. We're gratified to learn that many new patients call us based on your words of advice! If you are a doctor who is referring a patient to us, please download, print and complete the following form. Please fax or email a copy to Ottawa Children’s Dentistry and give the original to the patient. Thank you!

Download Patient Referral Form

Please Note: This form is subject to change by Ottawa Children's Dentistry. For the most up to date patient referral form, please refer to this page or contact our office for more information. You can reach our office via email at, call our office at 815-434-6447 or visit the contact page on this website.

Referring Doctor