Doctor Referral Form

Fill out our online referral form or click below for a download of the form.

Patient Name *

Patient Phone Number

Patient Email Address *

Practice Name

Practice Phone

Areas of concern

CrowdingSpacingOverjetImpacted ToothDeep BiteOpen BiteCrossbiteOther

Patient Interested in InvisalignYesNo

Restorative Treatment

Referring Doctor Name

Referring Doctor Phone Number

Practice Email

Radiographs Sent?YesNo

Comments on patient0 / 180

LOCATION

Sylmar Orthodontics
13910 Foothill Blvd
Sylmar CA 91342

MEET US

Home
About Dr Vossoughi
Treatment Options
Invisalign
Contact

Hours

Mon through Fri: 9 am – 6 pm
Sat: 8 am – 4 pm

Schedule Now

Sylmar Orthodontics offers the most effective orthodontic treatments available with financing which makes it more affordable than ever before. We create beautiful smiles for kids, teens and adults in and around Sylmar and San fernando, CA.

Dr Vossoughi offers the most advanced braces for children, braces for teens and adult braces, including: metal braces, Invisalign for adults, Invisalign for teens, and more. Call:(818) 336-6962 FREE Consultation for braces or Invisalign at our Sylmar Orthodontist office.