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. Robert Van WinckleDr. Nach DanielDr. Karim Al-Khatib
    Please select a Brockville doctor :   Dr. Stephen Ho
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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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