Prosthodontic Referrals Kelowna

Referrals

Dr James loves to work as partners when treatment planning, however there are times when you would like us to complete the entire treatment, as uch our Perio Prostho team can help your patients with this level of service if required. If you are new to Implant restorations we will work directly with you to help build confidence.

Patient Referral Form

At Dr. James’ Prosthodontics, we will endeavor to work closely with referring dental practitioners, offering expertise from diagnosis and treatment planing through to the execution of prosthodontic treatment in all aspects of reconstructive, aesthetic, and implant dentistry. For specific cases, we are happy to curate treatment plans that allow us to work together with you and your team. We can carry out a particular stage of the treatment if you wish to carry out the remaining treatment yourself/yourselves. We will keep you informed of the patient’s progress at every stage.

We offer 4 ways to refer: This form, telephone, email or fax.

Patient Details

Name(Required)

First Last

Email(Required)

Phone(Required)

Patient Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Patient Dental Information

Reason for Referral(Required)

Implant Preference

Patient Dental Insurance Information

Primary Carrier(Required)

Policy Number(Required)

ID/Cert Number(Required)

Insured(Required)

Employer/Plan Sponsor

Referring Dentist

Dentist Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Referral(Required)

Clinical Details(Required)