Centre Dentaire Bergeron Veilleux

Patient Referral Form

ATM Disorder / Occlusion:
Request for a 3D radiological scan (CBCT)
Drag & Drop Files, Choose Files to Upload
Please add the latest panoramic radiograph to the patient's file.If the patient does not have any radiographs in their file, please indicate this in the comments field.
Consent for the storing and use of your personal information for communicating with you.