REFERRING DOCTORS

Fusion Implant Dentistry offers dental implant services to patients throughout the Hamilton and Niagara region. Dr. Sajid Syed, has over 15 years’ experience successfully placing implants and has performed a variety of implant case complexities as well as standard tooth replacements.

We understand the need for a dental practice to have a reputable and professional dentist to refer patients to for Implantology while providing clear communication with your office about patient's treatment plan, and of course ensuring that they return to your office for the balance of their care.

For your patients who may be nervous and require sedation, we do offer IV sedation, oral sedation and nitrous at our clinics.

Patient Referral Form

Patient's Name:

Parent / Guardian's Name (if under 18 years old)

Phone / Cell:

E-mail:

Referring Office:

Referring Doctor:

Doctor's Phone:

Doctor's E-mail:

Radiographs

E-mailed

Provided with Patient

To be Taken

Reason for Referral

Implants

Removeable Prosthodontics

Periodontal Treatment

Fixed Prosthodontics

Extraction / Oral Surgery

Other

Remarks

Fusion Implant Dentistry - Referring-doctors

Referring Doctors

Patient Referral Form

Rebuilding Confidence, One smile at a time. Request your consultation today!