Brockville  Oral Surgery

135 Ormond St Suite 101
Brockville, ON K6V 5Y2

North Bay Oral Surgery

180 Shirreff Ave. Suite 240
North Bay, ON P1B 7K9

    Doctor Referral Form

    Preferred Clinic :   BrockvilleNorth Bay

    Please select a North Bay doctor :   Dr. Nick KatsikerisDr. Stephen HoDr. Johnson CheungDr. Ahmed Almuzayyen

    Please select a Brockville doctor :   Dr. Stephen HoDr. Ahmed Almuzayyen

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    Dental InsuranceIndian AffairsSocial AssistanceNot Applicable

    Type of treatment :
    ExtractionExposureTMJApical SurgeryPathologyImplantologyJaw SurgeryPreprosthetic Surgery

    Adult Teeth Charting

    D

    1817161514131211

    2122232425262728

    G

     

    4847464544434241

    3132333435363738

     

    Youth Teeth Charting:

    D

    5554535251

    6162636465

    G

     

    8584838281

    7172737475

     

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