To refer a patient to our office for an examination, please enter their name and nature of the referral into the contact us box below. You can also download and complete the attached referral form and return to us by e-mail for fax.

Referral Form

Send completed referral forms by fax at (604) 532-1072 or email reception@langleyperio.com

We appreciate your referral and thank you for your support of our practice!