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Patient Referral Form

For dentists and dental offices only. Referring a patient to Radiant Dental? Fill out the form below and we’ll contact the patient to book their appointment.

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Panorama clinic

Unit 101, 6321 King George Blvd.
Panorama@radiantdentalgroup.com
(604)-595-1575
OPEN HOURS

Sunday - Monday: CLOSED

Tues, Wed, friday: 8:30AM - 5:30PM

Thursday: 11:00AM - 8:00PM

Saturday: 8:30AM - 4:30PM

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clayton clinic

Unit 140, 18811 72 Avenue.
Clayton@radiantdentalgroup.com
(604)-595-1575
OPEN HOURS

Sunday: 10:00AM - 4:00PM

Mon - Tuesday: 8:30AM - 5:30PM

Wed. Thurs, Fri, & Saturday: CLOSED

Referring Office

Patient Information

Date of Birth
Year
Month
Day

Referral Details

Clinic Location

Please email the patient’s X-rays to the clinic you selected, with the patient’s full name in the subject line:


Panorama: Panorama@radiantdentalgroup.com

Clayton Heights: Clayton@radiantdentalgroup.com

Treatment Requested
Urgency
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