/  Referral Form

Referral Form

If you would like to refer your patient to our office, please complete the Referral Form.
The form can be printed, completed, and faxed or emailed to us.
If you would like to request copies of the form, please contact our office and we will mail them to you.
Burnaby
Fax : 604 568 6219
E-mail : burnaby@tomleedental.com
Langley
Fax : 604 514 6492
E-mail : langley@tomleedental.com
New Westminster
Fax : 604 525 1136
E-mail : newwest@tomleedental.com
Coast Meridian
Fax : 604 942 1139
E-mail : coastmeridian@tomleedental.com