Doctor Referral

(250) 763-3312
info@kelownabraces.ca
102-1110 Harvey Ave, Kelowna, BC

About Us
- About Our Orthodontists
- About Our Team
Patient Info
Treatment Options
Doctor Referral

About Us
- About Our Orthodontists
- About Our Team
Patient Info
Treatment Options
Doctor Referral

Thank you for showing your confidence in our practice by recommending us to your patients. Please fill out the referral form below.

Download Referral PDF

A successful practice doesn’t just happen. It is the result of a strong commitment to excellence in our treatment and in our relationships with patients and other doctors. We’d like to take a moment to thank you for showing your confidence in our practice by recommending us to your patients. We’re gratified to learn that many new patients call us based on your words of advice!

Please Select an Office and Preferred Doctor

Mission Creek Orthodontics

First Available

Dr. Derek Pollard

Dr. Diego Diaz

Dr. Jessica Kehler

Kelowna Orthodontics

First Available

Dr. Derek Pollard

Dr. Diego Diaz

Dr. Jessica Kehler

West Kelowna Orthodontics

First Available

Dr. Derek Pollard

Dr. Diego Diaz

Dr. Jessica Kehler

Dr. Glenn Perrin

Please fill out the following information about your patient

Patient Name(Required)

First Last

Gender(Required)

D.O.B.(Required)

MM slash DD slash YYYY

Parent/Guardian Name(s)

Phone(Required)

Patient's Email

Reason for Referral

Is there any dental work outstanding?

Yes

Have any PANORAMIC or cephalometric radiographs been taken in the past 3 years? (If yes, please upload imaging in the next step)

Yes

Please upload panoramic or cephalometric radiographs from the past 3 years

Max. file size: 64 MB.

When was panoramic or cephalometric radiograph taken?

MM slash DD slash YYYY

Would you like a call from the Orthodontist before or after the examination to discuss the case?

Yes, before

Yes, after

Not required

Referred by Dr.(Required)

Date

MM slash DD slash YYYY

Doctor Email(Required)

We'll send you a copy of this referral form.

Why Choose Our Practice

Patient First Approach

We put your needs first to achieve efficient and comprehensive treatment in a supportive and nurturing environment.

Welcoming Team

We know that our office is only as effective and as welcoming as the people who work in it, which is why we take pride in our friendly and well-trained team members.

Interest Free Payments

We understand that orthodontic treatment can be a big investment. To help fit it into your specific budget, we are happy to offer zero-interest payment arrangements.

Our Satisfied Patients

We love hearing from our patients! Thank you to everyone who has taken the time to provide us with feedback. It means the world to us!

The staff was so friendly. Dr Pollard was so kind and informative. An excellent experience and very trustworthy!

Jonelle S.Review on Google

They are always helpful and efficient and have made myself and my daughter feel at ease about any of the procedures needed.

Tamiko K.Review on Google

The staff here are amazing. Very friendly and accommodating. The office is clean and comfortable. They offer great payment plans and options. I highly recommend them for your orthodontic needs.

Lisa M.Review on Google