Referral for IV Sedation

Dr. Harmeet Dhaliwal BSc, DDS
Dr. Navdeep Dhaliwal BSc, DDS
15 Masters Drive SE #180
Calgary AB T3M 3M3
Ph: (403) 744-5285

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PATIENT INFORMATION

REFERRING DENTIST/PRACTICE INFORMATION

REASON FOR REFERRAL

Oral Surgery
Restorative

(Please specify tentative treatment plan)

 
 
Radiographs
Tenative Treatment Plan
+

PATIENT RETURN

All patients will be returned to you for recare, unless otherwise specified.