Referral Forms for Dentists

For Referrals to the Graduate Programs Clinic

The Graduate Programs Clinic at UBC Dentistry accepts patient referrals for complex cases in endodontics, orthodontics, pediatric dentistry, periodontics, and prosthodontics. All of these programs require a referral from a dentist.


* The General Referral Form should be printed, filled in (by pen) and faxed to the Graduate Programs Clinic. The fax number is on the form.

** The Endodontics Referral Form can be printed, filled in (by pen), and faxed or it can be filled in online and submitted as an e-mail attachment. You may also attach radiographic images to the e-mail message. To fill in the Endodontics Referral Form online you must be using free Adobe Acrobat Reader as your PDF viewer. Other PDF viewers wil not work. You also need a desktop e-mail program, such as Outlook, Outlook Express, Apple Mail, etc. Web-based e-mail (Hotmail, Gmail, Yahoo! Mail, etc.) will not work.