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For Referring Offices

Refer a Patient to VIVA Orthodontics

Thank you for trusting us with your patient’s care. Send a referral online in a couple of minutes, or download our printable referral form to complete by hand.

Two ways to refer

Choose whichever suits your office

Both routes reach the same team at VIVA Orthodontics. Use the printable pad if your office prefers paper, or send the referral online.

Printable referral form

Download the one page referral pad, complete it by hand, and send it with your patient or email it to our team.

Download the PDF

PDF, one page, ready to print.

Online referral form

Complete the same fields online and submit. Your referral reaches our clinical team straight away, with no printing or faxing.

Refer online

Takes about two minutes.

  1. Send the referral

    Submit the online form, or send the completed printed pad with your patient.

  2. Send the radiographs

    Email any relevant records to info@vivaortho.ca, or send them with the patient.

  3. We arrange the consultation

    Our team contacts your patient to book their initial appointment at our Waterdown office.

Online referral form

Fields marked with an asterisk are required. Please do not attach radiographs here, email them to info@vivaortho.ca.

Referring doctor and clinic

Patient information

Referral details

What are your primary concerns regarding this patient? Check all that apply.

Radiographs

Hygiene (cleaning)

Additional comments

Please send any radiographs to info@vivaortho.ca

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105 Clappison Ave #104, Waterdown, ON L8B 1W2