No Referrals Necessary!
Healthy Life, Healthy Smile, Happy Patients
“Certified Specialists in Periodontics and Implant Dentistry”
306-933-2777
Fax: 306-933-2790
302 201 1st Ave S • Saskatoon, SK S7K 1J5
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Treatments
Comprehensive Periodontal Examination
Periodontal Therapy
Tissue Regeneration
Cosmetic Gum Procedures
Gum Graft Surgery
Teeth Extractions
Bone Grafts/ Ridge Modification
Dental Implants
Sinus Lift Surgery
Crown Lengthening
Gingivectomy
Frenectomy
Tooth Exposures
About Us
Meet Our Periodontist
Meet Our Staff
Meet Our Hygienists
Meet Our Assistants
Meet Our Front Desk
Patient Information
Our Mission
First Visit
Financial Policy
Scheduling
Patient Forms & Instructions
Patient Testimonials
Photo Gallery
PerioCentre Sitemap
Home
Treatments
Comprehensive Periodontal Examination
Periodontal Therapy
Tissue Regeneration
Cosmetic Gum Procedures
Gum Graft Surgery
Teeth Extractions
Bone Grafts/ Ridge Modification
Dental Implants
Sinus Lift Surgery
Crown Lengthening
Gingivectomy
Frenectomy
Tooth Exposures
About Us
Meet Our Periodontist
Meet Our Staff
Meet Our Hygienists
Meet Our Assistants
Meet Our Front Desk
Patient Information
Our Mission
First Visit
Financial Policy
Scheduling
Patient Forms & Instructions
Patient Testimonials
Photo Gallery
Patient Name
*
Date of Birth
*
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YYYY
Address
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
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Postal Code
Patient Home #
Patient Cell #
*
Patient Email
*
Medical History
REASON FOR REFERRAL
Comprehensive Periodontal Examination
Comprehensive Periodontal Examination
Limited Periodontal Examination
Limited Periodontal Examination
Limited Checkboxes
Tooth extraction/Ridge Preservation
Crown Lengthening
Surgical exposure of impacted teeth
Gingival recession/soft-tissue grafting
Frenectomy
More referral forms required
Maxillary sinus augmentation
Implants
Peri-implantis
Nobel
Pathology/Biopsy
Zimmer
Gingivectomy
Straumann
Other
Other
Radiographs
Radiographs
E-mailed
Sent by mail
Not available
Notes
REFERRED BY
Doctor
*
Phone
*
Dentist Email
*
Date
*
DD
MM
YYYY
Address
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Consultation Check-boxes
Please call the patient to schedule a consultation
A consultation appointment has been made
60769
Get In Touch With Us
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8559
PerioCentre
|
302 201 1st Ave S
•
Saskatoon
,
SK
S7K 1J5
|
306-933-2777
|