New Patient Referral Form for 2019:
Please download a copy as your reference.
Please email or fax it back to us and we will contact the patient directly for an appointment.
Printed Map Direction for Patient
Please download a copy as your reference.
Please give a copy to the patient as a map for directions.
Interpretation Only Form:(Recommended: use your own office letterhead)
Please download a copy as your reference
Email it back along with the imaging to us and we will reply accordingly
- X-ray in digital (PA or Pan) - Per the by law of BC Dental College, please do not email x-rays
- Image must be in Jpeg or Png Format
- Include patient's name and Date of birth with a brief message when upload images
- Indicate type of reply desired: Verbal or Written (different fee may apply)
- Specify date and time with a phone number for return calls for verbal reply selection
- Do not send Digital X-Ray in regular paper prints
- Upload to our secure website:
(cut and paste the link or simply click the button below to start uploading)
https://spaces.hightail.com/uplink/cbct
Copyright Advanced BC Dental Diagnostic Inc. 2008. All rights reserved.