Referring Doctors

Refer a Patient

We warmly welcome your referrals and deeply value your continued trust in our practice. We offer dedicated emergency services to ensure your urgent cases are seen promptly. Please complete our secure online referral form, or download a printable version. You can also upload images/files through our online portal or email them to reception@oakvilleendo.ca.

Oakville Endodontics

Patient Information

Details of the patient being referred

Patient First Name

Patient Last Name

Patient Phone Number

Patient Email Address

Date of Birth

Format: DD/MM/YYYY

Tooth Number(s)

Reason for Referral & Additional Comments

Insurance Details

Coverage and CDCP eligibility

Does the patient have dental insurance?

Yes No

Patient is covered under the CDCP (Canadian Dental Care Plan)

Patient Home Address

CDCP Member ID

Referring Office

Your practice details

Referring Dentist Name

Referring Office Name

Referring Office Email

X-rays / Radiographs

Attach imaging for the referral

Click to choose files or drag & drop

JPG, PNG, TIFF, PDF, ZIP and more. DICOM (.dcm) is not accepted — please export to an image or PDF first.

This is an urgent / emergency referral

Oakville Endodontics

Dr. Harkaran Bajwa M.D.S. Cert. Endo.

152 Trafalgar Road, 2nd Floor, Oakville ON L6J 3G6

For urgent cases, call (905) 338-2233 · reception@oakvilleendo.ca