Clinical referral

Refer a patient

Refer a patient to De Facto Dental Studio for evaluation, treatment or technical service. The patient remains under your clinical responsibility when applicable.

Form

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You can also become a partner or submit a prescription from this page.

Clinical referral

Refer a case

Refer a patient for shade matching, repair or technical service. The patient remains yours.

Refer a patient to Studio Dentaire De Facto for evaluation, treatment or technical services. The patient remains under your clinical responsibility.

01

Referring professional

10-digit Canadian format

02

Patient

10-digit Canadian format

03

Referral

Secondary reasons (optional)
Urgent *
Documents transmitted
04

Files

JPG, PNG or HEIC. Maximum 10 MB per photo.

JPG, PNG or PDF.

STL, OBJ, PLY or ZIP.

05

Consents

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