Refer a patient via info@simplyortho.ca, 780-756-7600, or submitting the following details:

A copy of this referral will be sent to the office email address provided below upon our receipt.

Every referral is very much appreciated!

Referring Office Details

Office/Referring Doctor Name

Office Email Address

Referral Details and Special Considerations

Panorex has been:

Mailed

E-mailed (info@SimplyOrtho.ca)

Given to Patient

No Panorex on File

Patient Details

Patient Name

Patient Phone Number

Birthdate

mm/dd/yyy

Parent/Guardian Name

E-mail Address

Simply Orthodontics is a specialty practice in Edmonton Alberta. Dr. Marguerite Duncan is a specialist licensed with the Alberta Dental Association, with a Master’s Degree in Orthodontics from the University of Alberta.

Simply Orthodontics | 10150 150 Street, Edmonton, AB, T5P 1P1 | Phone: 780-756-7600 Fax: 780-756-7070

Refer a Patient_