Referral Form

Referrals are always greatly appreciated at our family friendly dental office in Ajax. Please feel free to browse our website and learn more about our team and the dental services we offer. If you have any questions at all, give us a call and we woud be happy to assist.

You can save yourself some time by choosing from several options prior to your dental visit:

Option 1 – Click on PDF Fillable Form and, fill out the form, save and email to: info@westajaxdental.ca

Option 2 – Click on the Online Referral Form and, fill out the form and send by clicking on the Submit button at the end of the form.