{"id":141,"date":"2021-11-04T18:28:43","date_gmt":"2021-11-04T18:28:43","guid":{"rendered":"https:\/\/new.microendoperio.com\/formulaire-de-reference-en-endodontie\/"},"modified":"2025-12-11T20:56:03","modified_gmt":"2025-12-11T20:56:03","slug":"referral-form-for-endodontic","status":"publish","type":"page","link":"https:\/\/microendo.ca\/en\/referral-form-for-endodontic","title":{"rendered":"REFERRAL FORM FOR ENDODONTIC"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#f6f7fa&#8221; use_background_color_gradient=&#8221;on&#8221; background_color_gradient_stops=&#8221;#ffffff 0%|#f6f7fa 100%&#8221; background_color_gradient_start=&#8221;#ffffff&#8221; background_color_gradient_end=&#8221;#f6f7fa&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text _builder_version=&#8221;4.27.0&#8243; _dynamic_attributes=&#8221;link_option_url&#8221; _module_preset=&#8221;default&#8221; link_option_url=&#8221;@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF9saW5rX3VybF9wYWdlIiwic2V0dGluZ3MiOnsicG9zdF9pZCI6IjEwODcifX0=@&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><i class=\"fas fa-angle-left\"><\/i> Return to the site<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.16&#8243; text_font=&#8221;Open Sans||||||||&#8221; text_line_height=&#8221;2em&#8221; header_font=&#8221;||||||||&#8221; header_2_font=&#8221;Cantata One||||||||&#8221; header_2_font_size=&#8221;40px&#8221; header_2_line_height=&#8221;1.4em&#8221; header_3_font=&#8221;Cantata One||||||||&#8221; header_3_text_color=&#8221;#0081ff&#8221; header_3_font_size=&#8221;20px&#8221; header_3_line_height=&#8221;1.6em&#8221; header_2_font_size_tablet=&#8221;35px&#8221; header_2_font_size_phone=&#8221;25px&#8221; header_2_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2 style=\"text-align: center;\">REFERRAL FORM FOR ENDODONTIC<\/h2>\n<p style=\"text-align: center;\"><em>To refer your patient, please fill out the referral form online. <\/em><\/p>\n<p style=\"text-align: center;\"><em>You may also send it either by fax, by mail or give it to patient.<\/em><\/p>\n<p style=\"text-align: center;\"><em>When you have completed the form, click on the SUBMIT FORM button at the bottom of the page.<\/em><\/p>\n<p>&nbsp;<\/p>\n<p>[\/et_pb_text][et_pb_contact_form use_spam_service=&#8221;on&#8221; recaptcha_list=&#8221;Default|Default-0&#8243; email=&#8221;info@microendo.ca&#8221; title=&#8221;REFERRAL FORM FOR ENDODONTIC&#8221; success_message=&#8221;Your form has been successfully sent. 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field_title=&#8221;Your Email Address&#8221; field_type=&#8221;email&#8221; fullwidth_field=&#8221;on&#8221; _builder_version=&#8221;4.17.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_contact_field][\/et_pb_contact_form][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_font=&#8221;Open Sans||||||||&#8221; text_line_height=&#8221;2em&#8221; header_font=&#8221;||||||||&#8221; header_2_font=&#8221;Cantata One||||||||&#8221; header_2_font_size=&#8221;40px&#8221; header_2_line_height=&#8221;1.4em&#8221; header_3_font=&#8221;Cantata One||||||||&#8221; header_3_text_color=&#8221;#0081ff&#8221; header_3_font_size=&#8221;20px&#8221; header_3_line_height=&#8221;1.6em&#8221; header_2_font_size_tablet=&#8221;35px&#8221; header_2_font_size_phone=&#8221;25px&#8221; header_2_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>If you have radiographies to send, please transmit by email to <a href=\"mailto:info@microendo.ca\">info@microendo.ca<\/a>\u00a0<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Return to the siteREFERRAL FORM FOR ENDODONTIC To refer your patient, please fill out the referral form online. 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