Referral Form

Please kindly print and fill out the referral forms when referring your patients to our office. We will be in touch with them as soon as possible to arrange necessary appointments. If it is an urgent matter, please note "Urgent" on the referral form and we will make every effort to accommodate to your patient's needs.

Please fax or mail the completed referral forms. If you have digital x-rays, these x-rays can be emailed to the following email addresses.

  • Burnaby Sedation Dental: info@sedationdental.ca
  • Langley Sedation Dental: sedationdental@hotmail.ca


General Dentistry under Sedation Referral Form


General Anesthesia Forms


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