Patient referral

Referral form

Once we have received your referral, we will process your patient's solution expectations. Thank you for your trust !

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Name of referring dentist

Patient's information

Patient's full name
Separate by a comma
Click or drag files to this area to upload. You can upload up to 10 files.
Accepted formats .doc, .pdf, .jpg and .png
With the patient's consent, the recommended solution will be forwarded to the referring dentist and treatment team.
Clinique de prosthodontie du West-Island
Dr. François Chartrand, D.M.D., Dipl. Prostho., Prosthodontist

755, blvd Saint-Jean, office 206
Pointe-Claire (Quebec)
H9R 5M9

P 514 630-6620

Business Hours

Care is provided from Tuesday to Thursday, starting at 8am.


Free parking
Free Wi-Fi

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