At Clinique Evoro, your patients are in good hands.

You wish to entrust your patient to an experienced and human team? Dr Sarah Théberge specialist in oral and maxillofacial surgery offers pain-free high-quality care in wisdom teeth extraction, placement of dental implants and facial surgery.

Patient information

Last name

FIRST NAME

Date of birth

Email address

Phone (Home)

Phone (Work. cell.)

TREATING Specialist

X-Rays

Please name the xray files provided with the date at which it was taken.

Name of x-ray

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Date

Name of x-ray

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Date

Name of x-ray

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Date

Type of intervention

Type of implants

TYPE OF ANESTHESIA

Please, contact the patientThe patient will contact you

Patient communication

PhoneEmail

PREFERRED METHOD OF COMMUNICATION

Particular medical condition(s)

Date

Notes

Referent information

Last name

First name

Phone

Referent email

To refer a patient, please fill out the following form.

At Clinique Evoro, your patients are in good hands.

Patient information

Affected teeth

Referent information