Referral Form

Thank you for referring your patient to Sprout Kids Dentistry! We truly appreciate your trust in our team. We'll reach out to the family to schedule their consultation visit and keep you updated on their progress! 

Please note:
(1) The "Personal Details" section is for the child's information .
(2) We gather all previous x-rays before reaching out for scheduling. Please make sure you send previous radiographs to hello@sproutkids.ca. 
(3) We have a strict no-show policy for new patients. If the family does not arrive or short-cancels their first visit at our clinic, we'll let you know that they need a referral elsewhere.
(4) Our office does not accept assignment for private insurance. We let all families know when scheduling, but it helps if you give them a heads up that they should expect to pay at their visit!

REFERRING DOCTOR INFORMATION
PERSONAL DETAILS
Your personal details. Please review them and make any necessary adjustments.
FAMILY INFORMATION
REASON FOR REFERRAL
IMPORTANT QUESTIONS