Referral Forms

The following programs require a referral from a dentist.

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.

• General Referral Form* (.PDF)
  For orthodontics, pediatric dentistry, periodontics, and prosthodontics
• Endodontics Referral Form** (.PDF)
  For endodontics

Referrals to the Geriatric Dentistry Program

• Geriatric Dentistry Referral Form (.PDF)

* 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. To fill in the Endodontics Referral Form online you must be using free Adobe Acrobat Reader as your PDF viewer. Other PDF viewers may not work.