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Contact Us | Doctors Referral Form | Orthodontists serving Kelowna, BC (British Columbia), Iain Allan and Bill Mulgrew

Orthodontists
Dr. Iain Allan and
Dr. Bill Mulgrew
Orchard Plaza Professional Building
1890 Cooper Rd. | Suite 315
Kelowna, BC V1Y 8B7
TEL: 250-860-3111
FAX: 250-860-3124

Doctor's Referral Form

If you are a doctor who is referring a patient to us, please fill out and submit the following form.

Today's Date:
Your Name:
Your Practice Name:
Your Email Address:
Full Name of the Patient You Are Referring:
Radiographs Sent? Yes No
If yes, when were they sent?
Comments
Verification Code
(case sensitive):