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Refer a Patient

To refer a patient, please fill out a referral form using one of the options below.

We are thankful for your referrals and we will refer the patient back to you for future dental needs. A follow-up letter with be sent with details about the success of their treatment. Thank you for trusting us with the care of your patients. - The Reflections Dental Health Centre Team

(204) 777-6453

Option 1

Complete Online 

Please complete the form below*. To share additional patient files, please call our office for more information. 

Option 2

Download PDF

Please download our PDF referral form and email to our office using the contact information on the form. 

Download Form

Patient Information

Dentist Information

Your email address will be used to send you a confirmation of receipt and/or consultation report.

Referral Information

Additional Information

*IMPORTANT: Any form submitted by email must be encrypted, to ensure it is secure. By submitting an unencrypted email form, you are consenting to an unsecured email. Alternatively, please call our office to refer a patient. 

New Patients Always Welcome

Are you looking for a dentist in Winnipeg? At Reflections Dental Health Centre, we're accepting new patients. Contact us today to get started.  

Request Appointment

(204) 777-6453