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Procedures
For Referring Doctors
- Referral Form
- Educational Events
  - Education Day
For Patients
Resources
Locations
Contact

Refer A Patient

Refer A Patient

About
Procedures
For Referring Doctors
- Referral Form
- Educational Events
  - Education Day
For Patients
Resources
Locations
Contact

Referral Form

Contact Us

It is an honour to be included on your healthcare team. Thank you for entrusting your patients to us.

You may refer patients by filling out and submitting this secure online Referral Form or by printing out a blank form and returning it to us.

Patient Information
Name:*
First Last
Date of Birth:*
MM slash DD slash YYYY

(mm/dd/yyyy)
Date Submitted:*
MM slash DD slash YYYY

(mm/dd/yyyy)
Address:
City:
Province:
Postal Code:
Home Phone:
Cell Phone:*
Email:
Referral Information
Requested Surgeon:
- Dr. Ian Buckley
- Dr. Hassan G. Moghadam
- Dr. Kevin J. Butterfield
- Dr. Taylor P. McGuire
- Dr. Adam M. Irvine
- Dr. Andrew Wing Cheong Lee
Select Location:
Referring Dentist:*
Referring Dentist Email:*
Do You Have Radiographs or Documents to Upload?
- Yes
- No
- Given to Patient
File Upload:
(Upload up to 5 files, images and/or documents, with a maximum file size of 12MB per file.)
Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 12 MB, Max. files: 5.
Teeth or Area to be Treated
teeth
- 18
- 17
- 16
- 15
- 14
- 13
- 12
- 11
- 21
- 22
- 23
- 24
- 25
- 26
- 27
- 28
- 55
- 54
- 53
- 52
- 51
- 61
- 62
- 63
- 64
- 65
- 85
- 84
- 83
- 82
- 81
- 71
- 72
- 73
- 74
- 75
- 48
- 47
- 46
- 45
- 44
- 43
- 42
- 41
- 31
- 32
- 33
- 34
- 35
- 36
- 37
- 38
Treatment Information
Select one or more treatments:
- Implants
- Extractions
- Impacted Teeth
- Lesion
- Orthognathic Surgery
- Infection
- Others (please describe below)
Comments:
Email
This field is for validation purposes and should be left unchanged.

About Us

Argyle Associates Oral & Maxillofacial Surgeons is one of the largest, most established groups of its kind in Canada. Since 1976, we have provided the complete scope of oral and maxillofacial procedures.

Our Locations

BARRHAVEN:10-3091 Strandherd Drive
Barrhaven, ON K2G 4R9

ORLEANS & SURGICENTRE EAST: 750 Taylor Creek Drive
Orleans, ON K4A 0Z9

Our Locations

CARLING & SURGICENTRE WEST: 100‐2255 Carling Avenue
Ottawa, ON K2B 7Z5

KANATA: 15‐499 Terry Fox Drive
Kanata, ON K2T 1H7

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