Referral Form

Please fill out the form below to refer your family members, friends and colleagues to iDentity Orthodontics (one form has to be submitted for each referred patient.) We will contact you once your referral has become a patient to send you your $100 cheque. The patient you refer will also receive $100 towards their braces treatment.

Terms and Restrictions:

  • You can refer more than one person each person will receive $100 towards their treatment and you will get $100 per referred patient (your cheque will be sent to you once they start their treatment.)
  • Only referral submitted from 09/20/2021 to 10/31/2021 are qualified for the $100 referral fee and $100 credits towards patient’s treatment.

    I am

    Patient's Family/FriendDental Professional

    iDentity Orthodontics