Doctor Referral

We appreciate the trust you have in our team at Hometown Orthodontics and we look forward to collaborating with you to reach our mutual patients’ treatment goals.

To refer a patient to our office, please complete the Printable PDF or use the Referral Form below which complies with the Alberta’s Health Information Act recommendations.

  Referral Form - Printable PDF

Referring Office Details

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Please provide your full name
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Please provide a valid email address
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Please select one of the above
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Please provide a reason for referral

Patient Details

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Please provide patient's full name
Date of Birth
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Please provide patient's date of birth
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Please provide a valid phone number
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Please provide a valid email address
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Please provide a valid name
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Why Hometown Orthodontics

Free Consultation (Including Photos and X-rays)
Direct Billing to Insurance
Affordable Interest-Free Payment Plans
No Referrals Needed
4 Conviennent Locations

Make your dream smile a reality!

Your first consultation with us is completely free of charge and comes with no obligation. Don't have a referral from a dentist? No problem! We welcome new patients and will make you feel at home right away.

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