Refer a Patient


   Please choose one of our specialists:

Izchak Barzilay
  Prosthodontist
  416.322.6862


M.K. (Bobby) Baig
 Prosthodontist
 416.322.6862

Effrat Habsha
 Prosthodontist
 416.322.6862


Ryan Schure
 Periodontist
 416.322.6862



Peter Birek
 Periodontist
 416.486.3020


Amir Azarpazhooh
 Endodontist
 416.322.6862

David Chvartszaid
 Prosthodontist/Periodontist
 416.322.6862


Samuel Struss
 Oral Surgeon
 416.488.4225


Referring Doctor:

Doctor First Name:
*
Doctor Last Name:
*
Doctor Email Address:
*
Doctor Phone Number:
*
*required field
   


Radiographs to follow:
 

Submitted by:
 

Dentist
Other


2300 Yonge Street, Suite 905, Box 2334

Toronto ON M4P 1E4

info@buildyoursmile.com

YOUR SMILE. OUR SPECIALTY.



Patient Information:

Patient First Name:
*
Patient Last Name:
*
Patient Email Address:
*
Patient Phone Number:
*
*required field
   
 

 
Reason for Referral:

Implants
TMD/Pain
Removable Prosthodontics
Periodontal treatment
Fixed Prosthodontics
Root canal therapy
Extraction/oral surgery
Other


Additional Information:

We thank you for your referral and will contact your office to confirm intake. If there is anything we can do to serve you better, please let us know.





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2300 Yonge Street
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Toronto, Ontario Canada M4P 1E4

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