--- title: "Refer a patient | Ortho Laval" description: "Referral form for dentists and specialists. Refer a patient to Ortho Laval and attach X-rays or relevant documents if available." lang: en-CA json-ld: | [ { "@context": "https://schema.org", "@type": [ "Dentist", "MedicalBusiness", "LocalBusiness" ], "@id": "https://www.ortholaval.com/#clinic", "name": "Ortho Laval", "alternateName": "Clinique d'orthodontie Ortho Laval", "url": "https://www.ortholaval.com", "logo": "https://www.ortholaval.com/og-image.jpg", "image": "https://www.ortholaval.com/og-image.jpg", "telephone": "+1-450-934-7700", "email": "clinique@ortholaval.com", "foundingDate": "1996", "priceRange": "$$", "currenciesAccepted": "CAD", "paymentAccepted": "Cash, Credit Card, Debit, Insurance, Interest-free payment plans", "medicalSpecialty": "Orthodontics", "knowsAbout": [ "Orthodontics", "Invisalign", "Clear aligners", "Braces", "LightForce custom brackets", "Interceptive orthodontics for children", "Adult orthodontics", "Orthodontic emergencies" ], "availableService": [ { "@type": "MedicalProcedure", "name": "Invisalign clear aligners", "procedureType": "NonInvasive" }, { "@type": "MedicalProcedure", "name": "Orthodontic braces", "procedureType": "NonInvasive" }, { "@type": "MedicalProcedure", "name": "LightForce custom 3D-printed brackets", "procedureType": "NonInvasive" }, { "@type": "MedicalProcedure", "name": "Children orthodontic evaluation", "procedureType": "NonInvasive" }, { "@type": "MedicalProcedure", "name": "Adult orthodontic treatment", "procedureType": "NonInvasive" } ], "hasOfferCatalog": { "@type": "OfferCatalog", "name": "Orthodontic services", "itemListElement": [ { "@type": "Offer", "itemOffered": { "@type": "Service", "name": "Invisalign à Laval", "url": "https://www.ortholaval.com/fr/invisalign-laval" } }, { "@type": "Offer", "itemOffered": { "@type": "Service", "name": "Broches orthodontiques", "url": "https://www.ortholaval.com/fr/broches-laval" } }, { "@type": "Offer", "itemOffered": { "@type": "Service", "name": "Orthodontie pour enfants", "url": "https://www.ortholaval.com/fr/orthodontie-enfants" } }, { "@type": "Offer", "itemOffered": { "@type": "Service", "name": "Orthodontie pour adolescents", "url": "https://www.ortholaval.com/fr/orthodontie-adolescents-adultes" } }, { "@type": "Offer", "itemOffered": { "@type": "Service", "name": "Orthodontie pour adultes", "url": "https://www.ortholaval.com/fr/orthodontie-adultes" } }, { "@type": "Offer", "itemOffered": { "@type": "Service", "name": "Première consultation", "url": "https://www.ortholaval.com/fr/premiere-visite" } }, { "@type": "Offer", "itemOffered": { "@type": "Service", "name": "Urgence orthodontique", "url": "https://www.ortholaval.com/fr/urgence-orthodontique" } } ] }, "address": { "@type": "PostalAddress", "streetAddress": "300-1575, boul. de l'Avenir", "addressLocality": "Laval", "addressRegion": "QC", "postalCode": "H7S 2N5", "addressCountry": "CA" }, "geo": { "@type": "GeoCoordinates", "latitude": 45.5617, "longitude": -73.7492 }, "hasMap": "https://maps.google.com/?q=300-1575+boul+de+l'Avenir+Laval+QC+H7S+2N5", "openingHoursSpecification": [ { "@type": "OpeningHoursSpecification", "dayOfWeek": [ "Monday", "Tuesday" ], "opens": "07:30", "closes": "16:30" }, { "@type": "OpeningHoursSpecification", "dayOfWeek": [ "Wednesday", "Thursday" ], "opens": "07:30", "closes": "15:30" } ], "contactPoint": [ { "@type": "ContactPoint", "telephone": "+1-450-934-7700", "contactType": "reservations", "areaServed": "CA", "availableLanguage": [ "French", "English" ] } ], "areaServed": [ { "@type": "City", "name": "Laval" }, { "@type": "City", "name": "Montréal" }, { "@type": "Place", "name": "Rive-Nord" }, { "@type": "Place", "name": "Saint-Laurent" }, { "@type": "Place", "name": "Ville Mont-Royal" }, { "@type": "Place", "name": "Boisbriand" }, { "@type": "Place", "name": "Sainte-Thérèse" }, { "@type": "Place", "name": "Rosemère" } ], "aggregateRating": { "@type": "AggregateRating", "ratingValue": "4.9", "reviewCount": "104", "bestRating": "5", "worstRating": "1" }, "sameAs": [ "https://www.google.com/maps/place/Ortho+Laval/data=!4m2!3m1!1s0x4cc9223252388407:0x45c3bd36adee4fc6" ] }, { "@context": "https://schema.org", "@type": "Dentist", "@id": "https://www.ortholaval.com/#clinic", "name": "Ortho Laval", "alternateName": "Clinique d'orthodontie Ortho Laval", "description": "Clinique d'orthodontie spécialisée à Laval depuis 1996. Invisalign, broches orthodontiques et LightForce pour enfants, adolescents et adultes.", "url": "https://www.ortholaval.com", "telephone": "+1-450-934-7700", "email": "clinique@ortholaval.com", "image": "https://www.ortholaval.com/og-image.jpg", "priceRange": "$$", "foundingDate": "1996", "medicalSpecialty": "Orthodontics", "address": { "@type": "PostalAddress", "streetAddress": "300-1575, boul. de l'Avenir", "addressLocality": "Laval", "addressRegion": "QC", "postalCode": "H7S 2N5", "addressCountry": "CA" }, "geo": { "@type": "GeoCoordinates", "latitude": 45.5617, "longitude": -73.7492 }, "openingHoursSpecification": [ { "@type": "OpeningHoursSpecification", "dayOfWeek": [ "Monday", "Tuesday" ], "opens": "07:30", "closes": "16:30" }, { "@type": "OpeningHoursSpecification", "dayOfWeek": [ "Wednesday", "Thursday" ], "opens": "07:30", "closes": "15:30" } ], "areaServed": [ { "@type": "City", "name": "Laval" }, { "@type": "City", "name": "Montréal" }, { "@type": "Place", "name": "Rive-Nord de Montréal" }, { "@type": "Place", "name": "Saint-Laurent" }, { "@type": "Place", "name": "Ville Mont-Royal" } ], "availableService": [ { "@type": "MedicalProcedure", "name": "Invisalign", "procedureType": "Orthodontics" }, { "@type": "MedicalProcedure", "name": "Broches orthodontiques", "procedureType": "Orthodontics" }, { "@type": "MedicalProcedure", "name": "LightForce", "procedureType": "Orthodontics" }, { "@type": "MedicalProcedure", "name": "Orthodontie pour enfants", "procedureType": "Orthodontics" }, { "@type": "MedicalProcedure", "name": "Orthodontie pour adolescents", "procedureType": "Orthodontics" }, { "@type": "MedicalProcedure", "name": "Orthodontie pour adultes", "procedureType": "Orthodontics" } ], "physician": [ { "@type": "Physician", "name": "Dr Jean-Marc Dumoulin", "medicalSpecialty": "Orthodontics" }, { "@type": "Physician", "name": "Dr Emmanuel Suissa", "medicalSpecialty": "Orthodontics" } ], "aggregateRating": { "@type": "AggregateRating", "ratingValue": "4.9", "reviewCount": "180", "bestRating": "5", "worstRating": "1" }, "sameAs": [ "https://www.google.com/maps?q=Ortho+Laval" ] }, { "@context": "https://schema.org", "@type": "WebSite", "name": "Ortho Laval", "url": "https://www.ortholaval.com", "inLanguage": [ "fr-CA", "en-CA" ], "publisher": { "@id": "https://www.ortholaval.com/#clinic" } }, { "@context": "https://schema.org", "@type": "Dentist", "name": "Ortho Laval", "description": "Specialized orthodontic clinic in Laval offering Invisalign, braces, and LightForce for children, teens, and adults.", "url": "https://www.ortholaval.com", "telephone": "+14509347700", "email": "clinique@ortholaval.com", "address": { "@type": "PostalAddress", "streetAddress": "300-1575, boul. de l'Avenir", "addressLocality": "Laval", "addressRegion": "QC", "postalCode": "H7S 2N5", "addressCountry": "CA" }, "geo": { "@type": "GeoCoordinates", "latitude": 45.5617, "longitude": -73.7492 }, "openingHoursSpecification": [ { "@type": "OpeningHoursSpecification", "dayOfWeek": [ "Monday", "Tuesday" ], "opens": "07:30", "closes": "16:30" }, { "@type": "OpeningHoursSpecification", "dayOfWeek": [ "Wednesday", "Thursday" ], "opens": "07:30", "closes": "15:30" } ], "medicalSpecialty": "Orthodontics", "foundingDate": "1996", "areaServed": { "@type": "City", "name": "Laval" } } ] --- [450 934-7700](tel:4509347700)[450 232-7701](sms:4502327701) 300-1575, boul. de l'Avenir, Laval FR [![Ortho Laval — Orthodontiste à Laval](data:image/svg+xml,%3c?xml%20version='1.0'%20encoding='UTF-8'?%3e%3csvg%20xmlns='http://www.w3.org/2000/svg'%20xmlns:xlink='http://www.w3.org/1999/xlink'%20width='110'%20height='113.813'%20viewBox='0%200%20110%20113.813'%3e%3cdefs%3e%3cclipPath%20id='clip-path'%3e%3crect%20id='Rectangle_1'%20data-name='Rectangle%201'%20width='110'%20height='113.813'%20fill='%231e2430'%3e%3c/rect%3e%3c/clipPath%3e%3c/defs%3e%3cg%20id='Groupe_1'%20data-name='Groupe%201'%20clip-path='url\(%23clip-path\)'%3e%3cpath%20id='Tracé_1'%20data-name='Tracé%201'%20d='M.546,61.552H.007V57.793H.546A5.586,5.586,0,0,0,4.8,55.978,5.845,5.845,0,0,0,6.236,53.03a42.05,42.05,0,0,0,.29-6.112A42.037,42.037,0,0,0,6.235,40.8a5.86,5.86,0,0,0-1.441-2.941A5.588,5.588,0,0,0,.546,36.043H.007V32.284H.546a9.729,9.729,0,0,1,7.242,3.041,8.964,8.964,0,0,1,2.374,4.642,49.168,49.168,0,0,1,.31,6.952,49.158,49.158,0,0,1-.308,6.941,8.963,8.963,0,0,1-2.375,4.652A9.727,9.727,0,0,1,.546,61.552'%20transform='translate\(0.002%2010.432\)'%20fill='%231e2430'%3e%3c/path%3e%3cpath%20id='Tracé_2'%20data-name='Tracé%202'%20d='M85.691,61.552h-.54a9.734,9.734,0,0,1-7.242-3.041,8.968,8.968,0,0,1-2.372-4.642,49.1,49.1,0,0,1-.311-6.952,49.091,49.091,0,0,1,.31-6.941v-.011a8.963,8.963,0,0,1,2.372-4.642,9.731,9.731,0,0,1,7.242-3.041h.54v3.759h-.54A5.589,5.589,0,0,0,80.9,37.858a5.842,5.842,0,0,0-1.438,2.948,41.578,41.578,0,0,0-.291,6.112,41.533,41.533,0,0,0,.292,6.12,5.838,5.838,0,0,0,1.44,2.941,5.585,5.585,0,0,0,4.249,1.814h.54Z'%20transform='translate\(24.309%2010.432\)'%20fill='%231e2430'%3e%3c/path%3e%3cpath%20id='Tracé_3'%20data-name='Tracé%203'%20d='M35.814,61.261H31.236L25.131,48.974H19.555V61.261H15.611V32.46h10.83a8.585,8.585,0,0,1,6.112,2.227,7.932,7.932,0,0,1,2.382,6.03,8.1,8.1,0,0,1-1.71,5.258,7.714,7.714,0,0,1-3.877,2.539ZM19.555,45.254h6.621a5.135,5.135,0,0,0,3.547-1.166,4.206,4.206,0,0,0,1.265-3.332A4.239,4.239,0,0,0,29.7,37.4a5.1,5.1,0,0,0-3.528-1.184H19.555Z'%20transform='translate\(5.045%2010.489\)'%20fill='%231e2430'%3e%3c/path%3e%3cpath%20id='Tracé_4'%20data-name='Tracé%204'%20d='M45.664,61.261H41.72V36.219H33.955V32.46H53.428v3.759H45.664Z'%20transform='translate\(10.973%2010.489\)'%20fill='%231e2430'%3e%3c/path%3e%3cpath%20id='Tracé_5'%20data-name='Tracé%205'%20d='M74.324,61.261H70.38V48.624H58.719V61.261H54.775V32.46h3.944v12.4H70.38V32.46h3.944Z'%20transform='translate\(17.7%2010.489\)'%20fill='%231e2430'%3e%3c/path%3e%3cpath%20id='Tracé_6'%20data-name='Tracé%206'%20d='M36.816,93.051H32.609l-2.149-6.26H19.5l-2.149,6.26H13.144l10.273-28.8h3.166ZM20.752,83.11h8.5L25.034,70.718Z'%20transform='translate\(4.247%2020.762\)'%20fill='%231e2430'%3e%3c/path%3e%3cpath%20id='Tracé_7'%20data-name='Tracé%207'%20d='M45.591,93.051H42.473L33.3,64.25h4.155l6.58,21.133L50.611,64.25h4.155Z'%20transform='translate\(10.76%2020.762\)'%20fill='%231e2430'%3e%3c/path%3e%3cpath%20id='Tracé_8'%20data-name='Tracé%208'%20d='M76.052,93.051H71.844l-2.149-6.26H58.738l-2.149,6.26H52.38l10.273-28.8h3.164ZM59.988,83.11h8.5L64.27,70.718Z'%20transform='translate\(16.927%2020.762\)'%20fill='%231e2430'%3e%3c/path%3e%3cpath%20id='Tracé_9'%20data-name='Tracé%209'%20d='M86.588,93.051H72.45V89.292H82.644V64.25h3.944Z'%20transform='translate\(23.412%2020.762\)'%20fill='%231e2430'%3e%3c/path%3e%3cpath%20id='Tracé_10'%20data-name='Tracé%2010'%20d='M14.138,93.051H0V64.25H3.944V89.292H14.138Z'%20transform='translate\(0%2020.762\)'%20fill='%231e2430'%3e%3c/path%3e%3cpath%20id='Tracé_11'%20data-name='Tracé%2011'%20d='M3.944,28.8H0V0H14.138V3.758H3.944Z'%20transform='translate\(0%200\)'%20fill='%231e2430'%3e%3c/path%3e%3cpath%20id='Tracé_12'%20data-name='Tracé%2012'%20d='M86.588,28.8H82.644V3.758H72.45V0H86.588Z'%20transform='translate\(23.412%200\)'%20fill='%231e2430'%3e%3c/path%3e%3c/g%3e%3c/svg%3e)](/en) [Treatments](/en/traitements)[Invisalign](/en/invisalign-laval)[First Visit](/en/premiere-visite)[Our Team](/en/equipe)[Results](/en/resultats)[FAQ](/en/faq)[Contact Us](/en/nous-joindre) [Refer a patient](/en/referer-un-patient)[Book Appointment](/en/nous-joindre) [Book Appointment](/en/nous-joindre) For dentists & specialists # Refer a patient Want to refer a patient to Ortho Laval for an orthodontic evaluation? Complete the form below. You can also attach an X-ray or any relevant document to streamline care. - Simple, fast process - Attach X-rays or clinical documents - Sent directly to our team - Immediate email confirmation A · Patient information Patient first name\* Patient last name\* Patient phone\* Patient email Date of birth Parent / guardian (if minor) Reason for referral B · Referring professional Referring doctor name\* Profession / specialty Clinic name\* Phone\* Email\* Clinic address C · Case type Patient category — Request type — Clinical notes Mark this referral as urgent D · Attach documents You can attach an X-ray or any other relevant document if you have one. Drag files here, or click to browse PDF, JPG, PNG, HEIC, DOCX · 15MB per file · 30MB total E · ConsentI confirm I am authorized to share this information and these documents with Ortho Laval as part of a clinical referral. The information shared will be treated confidentially by our team. [Download PDF referral pad](/pad-reference-ortholaval.pdf)Send referral Paper method ## Printable referral pad Prefer paper? Download our printable referral pad. [Download PDF referral pad](/pad-reference-ortholaval.pdf) Have a question? Our team is available to assist you. - [450 934-7700](tel:4509347700) - [clinique@ortholaval.com](mailto:clinique@ortholaval.com) - 300-1575, boul. de l'Avenir Laval (QC) H7S 2N5 Your submissions are encrypted and stored securely. Only authorized Ortho Laval staff can access them. ![Ortho Laval](data:image/svg+xml,%3c?xml%20version='1.0'%20encoding='UTF-8'?%3e%3csvg%20xmlns='http://www.w3.org/2000/svg'%20xmlns:xlink='http://www.w3.org/1999/xlink'%20width='110'%20height='113.813'%20viewBox='0%200%20110%20113.813'%3e%3cdefs%3e%3cclipPath%20id='clip-path'%3e%3crect%20id='Rectangle_1'%20data-name='Rectangle%201'%20width='110'%20height='113.813'%20fill='%23fff'%3e%3c/rect%3e%3c/clipPath%3e%3c/defs%3e%3cg%20id='Groupe_1'%20data-name='Groupe%201'%20clip-path='url\(%23clip-path\)'%3e%3cpath%20id='Tracé_1'%20data-name='Tracé%201'%20d='M.546,61.552H.007V57.793H.546A5.586,5.586,0,0,0,4.8,55.978,5.845,5.845,0,0,0,6.236,53.03a42.05,42.05,0,0,0,.29-6.112A42.037,42.037,0,0,0,6.235,40.8a5.86,5.86,0,0,0-1.441-2.941A5.588,5.588,0,0,0,.546,36.043H.007V32.284H.546a9.729,9.729,0,0,1,7.242,3.041,8.964,8.964,0,0,1,2.374,4.642,49.168,49.168,0,0,1,.31,6.952,49.158,49.158,0,0,1-.308,6.941,8.963,8.963,0,0,1-2.375,4.652A9.727,9.727,0,0,1,.546,61.552'%20transform='translate\(0.002%2010.432\)'%20fill='%23fff'%3e%3c/path%3e%3cpath%20id='Tracé_2'%20data-name='Tracé%202'%20d='M85.691,61.552h-.54a9.734,9.734,0,0,1-7.242-3.041,8.968,8.968,0,0,1-2.372-4.642,49.1,49.1,0,0,1-.311-6.952,49.091,49.091,0,0,1,.31-6.941v-.011a8.963,8.963,0,0,1,2.372-4.642,9.731,9.731,0,0,1,7.242-3.041h.54v3.759h-.54A5.589,5.589,0,0,0,80.9,37.858a5.842,5.842,0,0,0-1.438,2.948,41.578,41.578,0,0,0-.291,6.112,41.533,41.533,0,0,0,.292,6.12,5.838,5.838,0,0,0,1.44,2.941,5.585,5.585,0,0,0,4.249,1.814h.54Z'%20transform='translate\(24.309%2010.432\)'%20fill='%23fff'%3e%3c/path%3e%3cpath%20id='Tracé_3'%20data-name='Tracé%203'%20d='M35.814,61.261H31.236L25.131,48.974H19.555V61.261H15.611V32.46h10.83a8.585,8.585,0,0,1,6.112,2.227,7.932,7.932,0,0,1,2.382,6.03,8.1,8.1,0,0,1-1.71,5.258,7.714,7.714,0,0,1-3.877,2.539ZM19.555,45.254h6.621a5.135,5.135,0,0,0,3.547-1.166,4.206,4.206,0,0,0,1.265-3.332A4.239,4.239,0,0,0,29.7,37.4a5.1,5.1,0,0,0-3.528-1.184H19.555Z'%20transform='translate\(5.045%2010.489\)'%20fill='%23fff'%3e%3c/path%3e%3cpath%20id='Tracé_4'%20data-name='Tracé%204'%20d='M45.664,61.261H41.72V36.219H33.955V32.46H53.428v3.759H45.664Z'%20transform='translate\(10.973%2010.489\)'%20fill='%23fff'%3e%3c/path%3e%3cpath%20id='Tracé_5'%20data-name='Tracé%205'%20d='M74.324,61.261H70.38V48.624H58.719V61.261H54.775V32.46h3.944v12.4H70.38V32.46h3.944Z'%20transform='translate\(17.7%2010.489\)'%20fill='%23fff'%3e%3c/path%3e%3cpath%20id='Tracé_6'%20data-name='Tracé%206'%20d='M36.816,93.051H32.609l-2.149-6.26H19.5l-2.149,6.26H13.144l10.273-28.8h3.166ZM20.752,83.11h8.5L25.034,70.718Z'%20transform='translate\(4.247%2020.762\)'%20fill='%23fff'%3e%3c/path%3e%3cpath%20id='Tracé_7'%20data-name='Tracé%207'%20d='M45.591,93.051H42.473L33.3,64.25h4.155l6.58,21.133L50.611,64.25h4.155Z'%20transform='translate\(10.76%2020.762\)'%20fill='%23fff'%3e%3c/path%3e%3cpath%20id='Tracé_8'%20data-name='Tracé%208'%20d='M76.052,93.051H71.844l-2.149-6.26H58.738l-2.149,6.26H52.38l10.273-28.8h3.164ZM59.988,83.11h8.5L64.27,70.718Z'%20transform='translate\(16.927%2020.762\)'%20fill='%23fff'%3e%3c/path%3e%3cpath%20id='Tracé_9'%20data-name='Tracé%209'%20d='M86.588,93.051H72.45V89.292H82.644V64.25h3.944Z'%20transform='translate\(23.412%2020.762\)'%20fill='%23fff'%3e%3c/path%3e%3cpath%20id='Tracé_10'%20data-name='Tracé%2010'%20d='M14.138,93.051H0V64.25H3.944V89.292H14.138Z'%20transform='translate\(0%2020.762\)'%20fill='%23fff'%3e%3c/path%3e%3cpath%20id='Tracé_11'%20data-name='Tracé%2011'%20d='M3.944,28.8H0V0H14.138V3.758H3.944Z'%20transform='translate\(0%200\)'%20fill='%23fff'%3e%3c/path%3e%3cpath%20id='Tracé_12'%20data-name='Tracé%2012'%20d='M86.588,28.8H82.644V3.758H72.45V0H86.588Z'%20transform='translate\(23.412%200\)'%20fill='%23fff'%3e%3c/path%3e%3c/g%3e%3c/svg%3e) Orthodontic specialist in Laval since 1996 [450 934-7700](tel:4509347700) [Text](sms:4502327701) [Email](mailto:clinique@ortholaval.com) [](https://www.facebook.com/ortholaval/)[](https://www.instagram.com/ortho_laval/) ![Ortho 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