Online Referral Form

Dear Doctor,

We would like to thank you for your referral. We appreciate your confidence in allowing us to be involved in your patient care.

Please feel free to discuss any of questions or concerns regarding your patient with Dr. Saini. Dr. Saini will be happy to be of any assistance with your patient care.

Please contact our office at (604) 336-7411 or email us at reception@blissoralwellness.ca for our Vancouver location OR (604) 498-0100 or email us at info@blissoralwellness.ca for our Surrey location

A separate report will be sent to the office updating you on the diagnosis and management of your patient after the initial visit.

You can download the referral form from the website or fill in the online referral form. We could also mail the referral forms to your office at the earliest. Please contact our office for the same.

We look forward to contributing to your patient community in a meaningful manner.


Patient Information


Patient Name:
Address:
Date of Birth:
Phone/Email:

Referring Information


Reason for Referral:







Notes:

Referred By:
Location:

Download Referral Form

Online Form

Contact Us


Surrey Office

Phone: (604) 498-0100

Phone: (604) 498-0100

Fax: (604) 498-0244

Email: info@blissoralwellness.ca

Address: 9655 King George Blvd. Unit # 170 Surrey, B.C. V3T 0C7

The clinic is located just across Surrey Memorial Hospital on King George Blvd. and 96th Avenue.

Vancouver Office

Phone: (604) 336-7411

Phone: (604) 336-7411

Fax: (604) 336-7412

Email: reception@blissoralwellness.ca

Address: 1217 Kingsway Vancouver BC V5V 3E2

Nanaimo Office

Phone: 250-586-9995

Phone: 250-586-9995

Fax: 604-498-0244

Email: oralmedicinenanaimo@blissoralwellness.ca



Victoria Office

Phone: 250-590-5932

Phone: 250-590-5932

Fax: 604-336-7412

Email: oralmedicinevictoria@blissoralwellness.ca