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

REFER A PATIENT

1 Step 1
Refering dentist/physician name
Patient name
Patient telephone number
phone
Birth dateBirth date
date_range
Upload your X-raysupload
cloud_uploadUpload your X-rays
Consultation reason
Select a doctor
Survey
Code 1 very urgentCode 2 semi urgent (4 to 8 weeks)Code 3 according to our availabilityCode 4Code 5
Level of emergency
Comments
0 /
keyboard_arrow_leftPrevious
Nextkeyboard_arrow_right