Refer a Patient

Name: EJC Dentistry
Address: 118 Stinson St, Hamilton, ON, L8N 1S5, CA
Telephone: (905) 522-1188

Patient's First Name *

Patient's Last Name *

Date of Birth *

City *

Phone Number *

First Name *

Last Name *

Email Address *

Your email address will be used to send you a confirmation of receipt and/or consultation report.

Phone Number *

What service are you referring the patient for? *

Provide additional details if possible.

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*To share additional patient files, please call our office for more information.

We Look Forward to Your Smile

We are accepting new patients! Please contact us to take the first step toward achieving your smile goals.