Need to Refer a Patient?

If you are a dentist, doctor or specialist looking to refer to an Orthodontist, we’d love you to consider Ortho Co. by completing the below form.

Our friendly team will contact the patient or their parent.

Thank you for trusting Ortho Co. with the care of your patient.

Referral form

Patient details

Orthodontic assessment required for:

Orthodontic Assessment Required for:

Dentist details

Submit your records (optional)

Maximum file size: 2.1MB

Your Smile,
Our Passion

Tailored Orthodontic Care for a Lifetime of Confidence

Our specialist orthodontist memberships and partners