10660 Yonge Street
Richmond Hill, ON
905 737 6868
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Menu
Home
About Us
Dr. Zahra Najirad
Our Team
Social Responsibilities
New Patients
First Visit
Payments
Insurance Inquiry Form
Patient Health Information Form
Blog
Treatments
Kids Orthodontics
Teenager Orthodontics
Adults Orthodontics
Invisalign
Retention (Retainer)
Types of Braces
3D iTero Scanner
Accelerated Treatment
Gallery
Before & After
Videos
FAQs
Contact Us
Virtual Consultation
Online Booking
Refer a Patient
تماس با ما
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Home
About Us
Dr. Zahra Najirad
Our Team
Social Responsibilities
New Patients
First Visit
Payments
Insurance Inquiry Form
Patient Health Information Form
Blog
Treatments
Kids Orthodontics
Teenager Orthodontics
Adults Orthodontics
Invisalign
Retention (Retainer)
Types of Braces
3D iTero Scanner
Accelerated Treatment
Gallery
Before & After
Videos
FAQs
Contact Us
Virtual Consultation
Online Booking
Refer a Patient
تماس با ما
Menu
Home
About Us
Dr. Zahra Najirad
Our Team
Social Responsibilities
New Patients
First Visit
Payments
Insurance Inquiry Form
Patient Health Information Form
Blog
Treatments
Kids Orthodontics
Teenager Orthodontics
Adults Orthodontics
Invisalign
Retention (Retainer)
Types of Braces
3D iTero Scanner
Accelerated Treatment
Gallery
Before & After
Videos
FAQs
Contact Us
Virtual Consultation
Online Booking
Refer a Patient
تماس با ما
Referral Pad
Patient Name
Referred by
Email
Please evaluate for orthodontic correction of the following
Crowding / Spacing
Crossbite / Functional Shift
Oral Habit / Tongue Thrust
Space Maintenance
Pre-Prosthetic Alignment
Other
Comments
Please call me before proceeding with treatment
This patient has no caries or periodontal disease and is ready to start orthodontic treatment as needed
This patient still needs to complete restorative / periodontal work before starting orthodontic treatment
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Phone Number
Message
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If you prefer a printed referral pad, you can simply download the PDF file below and print it with any printer
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