Referrals | Orthodontists

Our orthodontists welcome referrals from doctors and other dentists to our locations in Langley.

Orthodontic Patient Referrals

Thank you for considering Fraser Valley Orthodontics to provide orthodontic services for your patients.

We will always aim to provide the quality of care you and your patients expect with our convenient Langley location.

Please contact our office about the patient you are referring. Or, you can complete the form on this page, and a member of our team will be in touch.

Referring Doctor's Name: *

Referring Doctor's Phone Number: *

Referring Doctor's Email Address: *

Referring Doctor's Request: *

Please contact me about this patient.

Please contact the patient's parent or guardian directly.

Neither. I have suggested the patient contacts your office directly.

Patient's First Name: *

Patient's Last Name: *

Patient's Email Address: *

Patient's Phone Number: *

Other Notes:

Upload File Attachment (if applicable)

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