Referral Form

Ajax Dentist | Easy Online Referral Form Dentist in Ajax, ON

At West Ajax Dental & Prosthodontics- your Ajax dentist, we always welcome new patients, emergencies and referrals. Now, you can fill our Referral Form online.

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:

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.


Ontario Dental Association
Royal College Of Dental Surgeons Of Ontario
American College of Prosthodontists
Association Of Prosthodontists Of Canada
Association Of Prosthodontists Of Ontario
Association Of Prosthodontists Of Ontario
West Ajax Dental


(905) 683-3700



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West Ajax Dental
73 Old Kingston Rd,
Ajax, ON
L1T 3A6


Monday: 7:30 am - 5:30 pm
Tuesday: 10:00 am - 8:00 pm
Wednesday: 10:00 am - 8:00 pm
Thursday: 7:30 am - 5:30 pm
Friday: By Appointment Only
Saturday: By Appointment Only
Sunday: Closed

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