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Referral Form

Thank you for choosing Gateway Oral & Maxillofacial Surgery as your office of choice. Please fill in the required information, then continue by adding any radiograph image file (.jpg, .bmp or .tif) to be submitted.

You can also print a referral form to fax to the office at (780) 760-1502 by clicking Launch PDF button.


(To view form, you will need an Adobe Acrobat Reader installed.)

Procedures
Radiograph

How to Submit X-Rays

Please email any relevant X-rays to our office at office@gatewayos.com with the patient’s name in the subject line.

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