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Upload your X-rays/Forms

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Name of patient

Date of X-ray

FILL OUT THE REFERRAL FORM

Kenedy Ruth Dental Centre in Brampton offers prompt dental treatment for people of all ages. Please use the referral form below. If you have any questions, contact us.

 

PATIENT REFERRAL FORM

Patient name

Date

Female/Male

Phone number

Date of birth

I am referring our patient for the following symptoms (please check all that apply):

I am specifically concerned about the following condition(s)

Panoramic Radiography Attachment

Date of the Panoramic Radiography

Doctor

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Date​

Phone number

Fax

INFORMATION

Kenedy Ruth Dental Centre

6A-27 Ruth Ave

Brampton, ON, L6Z 4R2

Phone: 905-846-1595

Fax: 905-846-2432

Email: kenedyruthdentalcentre@yahoo.ca

HOURS

Monday
10:00 AM - 07:00 PM
Tuesday
10:00 AM - 06:00 PM
Wednesday
10:00 AM - 07:00 PM
Thursday
Closed
Friday
10:00 AM - 06:00 PM
Saturday
09:30 AM - 04:00 PM
Sunday
Closed

SERVICE AREA

  • Brampton 

  • Greater Toronto Area

SOCIAL

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