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Professional Referrals

At Northland Village Dental Centre, we are always accepting new patients, regardless of age. If you would like to refer a patient to our clinic, we welcome you to complete the form below. All information submitted will remain confidential.

Referring Doctor’s Information

Patient Information


Patient’s Responsible Party (ex. parent or guardian)

Request an Appointment

Request an Appointment

Dental issues can get worse over time if neglected.

Contact Us

Contact Us

If you have any queries, please don’t hesitate to reach out to us.

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