Dental Referral — Westwood Health

Dentist/Orthodontist

Have a patient that you would like us to see?

Fill in the form below or fax us at (416) 422-1514

Additional documents can also be emailed to westwoodhealth@gmail.com

For a full list of the services we provide, click Here

Referring Doctor

First Name

Last Name

Clinic Name

Clinic Number

Patient Name

First Name

Last Name

Patient Number

Diagnosis/Reason for Referral

Additional Notes

Please let us know if you are faxing or emailing any additional documents