Refer a Patient

A successful practice doesn't just happen; it is the result of a strong commitment to excellence in the professional community and in the relationships we build with our patients and colleagues. We appreciate your confidence in OMG Perio's staff to provide you with the proper and complete dental care in order to maintain good oral health. We  thank you for recommending our practice to your friends and family.

If you would like  to refer a patient to our practice, please provide us with the information below. Once you've completed the form, click on the SUBMIT button at the bottom of the page.

Practice Information

Bold Fields are required.

Referral Information

Radiographs Sent?

 

Requested Procedures

 

Please indicate for Requested Procedures


 

Book an Appointment.

The next step to improving your systemic health.
Book An Appointment

Contact Us

460 Main St E #301, Hamilton, ON L8N 1K4
Telephone: (905) 526-6078

Office Hours

Mon — Th: 8:00am to 5:00pm
Friday: 9:00am to 4:00pm
Sunday: By Appointment