info@maxillomauricie.com
819 378-4353
Zygoma Zaga Centers

REFER A PATIENT

1 Step 1
Consultation reason
Reason for referral

IT IS REQUIRED TO ADD A PHOTO

This photo helps us prioritize appointments and assess whether the patient’s condition has improved or worsened at the time of their visit with us.

What is your specialty ?
Is the patient currently in pain ?
Does the patient frequently experience headaches ?
Has the patient ever had a jaw or facial trauma ?
Does the patient feel a limitation in their mouth opening ?
Does the patient exhibit a parafunction?

Medication tried

How many different medications has the patient tried ?

Previous dental treatments

Occlusal splint
Occlusal adjustment
Oral medicine consultation
Orthodontic treatment

Previous biomechanical treatments

Physiotherapy
Chiropractic
Massage therapy
Osteopathy
Acupuncture
Have the patient and parent met with a breastfeeding consultant?Such a consultation is required before proceeding with a frenotomy.
What does the tongue-tip look like ?
Where is it fixed to the gum ?
How high can it lift (wide open mouth) ?
How far can it stick out ?
Have the patient and parent met with a breastfeeding consultant?Such a consultation is required before proceeding with a frenotomy.
What is the patient's TABBY score?Here's how to interpret the score: 8 and above = normal score; 6 to 7: limit score; 5 and below : possible tongue dysfunction
We will only meet patients with a score of 5 and below.

Suspicion of Dysplasia / Carcinoma

White lesion appearance
Risk factors
Have you attempted treatment?

Lichen planus

Reason for consultation
Symptoms
Have you attempted treatment?

Dexamethasone elixir to be taken for 2 weeks + follow-up in 1 month

Vesiculobullous disease/desquamative gingivitis

Reason for consultation
Symptoms
Have you attempted treatment?

Dexamethasone elixir to be taken for 2 weeks + follow-up in 1 month

Other

Symptoms
Have you attempted treatment?
Select a doctor
Level of emergency
Code 1 very urgent Code 2 semi urgent (4 to 8 weeks)Code 3 according to our availabilityCode 4Code 5
Level of emergency
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