{"id":1684,"date":"2026-09-24T03:33:45","date_gmt":"2026-09-24T07:33:45","guid":{"rendered":"https:\/\/centredentairedentown.com\/reference-en-parodontie\/"},"modified":"2026-09-24T10:24:26","modified_gmt":"2026-09-24T14:24:26","slug":"reference-in-periodontics","status":"publish","type":"page","link":"https:\/\/centredentairedentown.com\/en\/reference-in-periodontics\/","title":{"rendered":"Reference in Periodontics"},"content":{"rendered":"<div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-element--has-background vce-row--col-gap-30 vce-row-equal-height vce-row-content--top\" id=\"el-df3255c2\" data-vce-do-apply=\"all el-df3255c2\"><div class=\"vce-content-background-container\"><div class=\"vce-asset-background-simple-container vce-visible-all-only vce-asset-background-simple--style-cover vce-asset-background-simple--position-center-top\"><div class=\"vce-asset-background-simple\">\n              <div style='background-image: url(\"https:\/\/centredentairedentown.com\/wp-content\/uploads\/2026\/09\/Header_Parodontie_Dentiste_Saint-Leonard.jpg\");'  class=\"vce-asset-background-simple-item vcv-lozad\" ><\/div>\n              <noscript>\n                <div class=\"vce-asset-background-simple-item\" style=\"background-image: url(https:\/\/centredentairedentown.com\/wp-content\/uploads\/2026\/09\/Header_Parodontie_Dentiste_Saint-Leonard.jpg)\"><\/div>\n              <\/noscript>\n            <\/div><\/div><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-71p vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-first vce-col--lg-first vce-col--xl-first padding365t\" id=\"el-ad7613d8\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-ad7613d8\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-ad7613d8\"><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-0 padding60x vce-row-equal-height vce-row-content--top\" id=\"el-f93524a0\" data-vce-do-apply=\"all el-f93524a0\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-1b5aed41\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-1b5aed41\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-1b5aed41\"><div class=\"vce-text-block font64 semibold white padding150b\"><div class=\"vce-text-block-wrapper vce\" id=\"el-eac898b2\" data-vce-do-apply=\"all el-eac898b2\"><h1 data-prosemirror-content-type=\"node\" data-prosemirror-node-name=\"paragraph\" data-prosemirror-node-block=\"true\" data-pm-slice=\"1 1 [&quot;bulletList&quot;,{&quot;localId&quot;:null},&quot;listItem&quot;,{&quot;localId&quot;:null}]\">Reference in Periodontics<\/h1><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-col vce-col--md-29p vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last\" id=\"el-07831e46\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-07831e46\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-07831e46\"><div class=\"vcv-row-control-wrapper\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 padding75x  vce-row-equal-height vce-row-content--top\" id=\"el-0fe7e543\" data-vce-do-apply=\"all el-0fe7e543\"><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-7d829ba6\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-7d829ba6\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-7d829ba6\"><div class=\"vce-shortcode font14\"><div class=\"vce-shortcode-wrapper vce\" id=\"el-952c9b80\" data-vce-do-apply=\"all el-952c9b80\"><nav aria-label=\"breadcrumbs\" class=\"rank-math-breadcrumb\"><p><span class=\"last\">Accueil<\/span><\/p><\/nav><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-row--col-gap-30 padding75x padding150b  vce-row-equal-height vce-row-content--top\" id=\"el-7fa5d41b\" data-vce-do-apply=\"all el-7fa5d41b\"><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-92835449\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-92835449\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-92835449\"><div class=\"vce-row-container\" data-vce-boxed-width=\"true\"><div class=\"vce-row vce-element--has-background vce-row--col-gap-30 padding100x padding100t padding100b vce-row-equal-height vce-row-content--top\" id=\"el-0d945384\" data-vce-do-apply=\"all el-0d945384\"><div class=\"vce-content-background-container\"><\/div><div class=\"vce-row-content\" data-vce-element-content=\"true\"><div class=\"vce-col vce-col--md-auto vce-col--xs-1 vce-col--xs-last vce-col--xs-first vce-col--sm-last vce-col--sm-first vce-col--md-last vce-col--lg-last vce-col--xl-last vce-col--md-first vce-col--lg-first vce-col--xl-first\" id=\"el-9229156e\"><div class=\"vce-col-inner\" data-vce-do-apply=\"border margin background  el-9229156e\"><div class=\"vce-col-content\" data-vce-element-content=\"true\" data-vce-do-apply=\"padding el-9229156e\"><div class=\"vce-text-block font48 white center padding35b\"><div class=\"vce-text-block-wrapper vce\" id=\"el-f711e7ce\" data-vce-do-apply=\"all el-f711e7ce\"><h2>Periodontist Referral Form<\/h2><\/div><\/div><div class=\"vce-text-block padding50b white center max70 aunderline\"><div class=\"vce-text-block-wrapper vce\" id=\"el-dbf9e513\" data-vce-do-apply=\"all el-dbf9e513\"><div class=\"ahS2Le\">\n<div class=\"F9yp7e ikZYwf LgNcQe\" dir=\"auto\" role=\"heading\" aria-level=\"1\">\n<p dir=\"ltr\">Please fill out the form below to refer a patient for a periodontal consultation with Dr. Rouzbeh Ostadsharif Memar, periodontist.<\/p>\n<p dir=\"ltr\">Following the consultation, a report will be sent to you. The patient will also be asked to return to your office for the follow-up of their oral hygiene and to continue their regular dental care.<\/p>\n<p dir=\"ltr\">If radiographs are available and are not included in the file, please send them by email to: <strong><a href=\"mailto:rouzbeh.memar.dds@gmail.com\">rouzbeh.memar.dds@gmail.com<\/a><\/strong><\/p>\n<\/div>\n<\/div>\n<div class=\"cBGGJ OIC90c\" dir=\"auto\">\n<p>&nbsp;<\/p>\n<\/div><\/div><\/div><div class=\"vce-shortcode\"><div class=\"vce-shortcode-wrapper vce\" id=\"el-649f51e5\" data-vce-do-apply=\"all el-649f51e5\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1682-o1\" lang=\"en-CA\" dir=\"ltr\" data-wpcf7-id=\"1682\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/1684#wpcf7-f1682-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1682\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_CA\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1682-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"form-page-contact form-paro\">\n\t<div class=\"paro-field\">\n\t\t<p><label for=\"paro-patient-name\" class=\"lab semibold\">Patient's first and last name: <span class=\"req\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patient-nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"paro-patient-name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"patient-nom\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"paro-field\">\n\t\t<p><label for=\"paro-patient-phone\" class=\"lab semibold\">Patient's phone number: <span class=\"req\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patient-tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" id=\"paro-patient-phone\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"patient-tel\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"paro-field\">\n\t\t<p><label for=\"paro-patient-address\" class=\"lab semibold\">Patient's address: <span class=\"req\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patient-adresse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"paro-patient-address\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"patient-adresse\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"paro-field\">\n\t\t<p><label for=\"paro-dentist-name\" class=\"lab semibold\">Referring dentist's name: <span class=\"req\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dentiste-nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"paro-dentist-name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"dentiste-nom\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"paro-field\">\n\t\t<p><label for=\"paro-dentist-email\" class=\"lab semibold\">Referring dentist's email address (for the report): <span class=\"req\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dentiste-courriel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" id=\"paro-dentist-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"dentiste-courriel\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"paro-field\">\n\t\t<p><span class=\"lab semibold\">Type and reason for the consultation: <span class=\"req\">*<\/span><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"type-consultation\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"type-consultation\" value=\"Complete examination\" \/><span class=\"wpcf7-list-item-label\">Complete examination<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"type-consultation\" value=\"Specific examination\" \/><span class=\"wpcf7-list-item-label\">Specific examination<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"type-consultation\" value=\"Soft tissue graft\" \/><span class=\"wpcf7-list-item-label\">Soft tissue graft<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"type-consultation\" value=\"Periodontal disease management\" \/><span class=\"wpcf7-list-item-label\">Periodontal disease management<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"type-consultation\" value=\"Dental implants\" \/><span class=\"wpcf7-list-item-label\">Dental implants<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"type-consultation\" value=\"Biopsy and oral pathology\" \/><span class=\"wpcf7-list-item-label\">Biopsy and oral pathology<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"type-consultation\" value=\"Other (please specify)\" \/><span class=\"wpcf7-list-item-label\">Other (please specify)<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"paro-field\">\n\t\t<p><label for=\"paro-details\" class=\"lab semibold\">Please specify the reason for the consultation and indicate the tooth numbers or the oral region to be evaluated: <span class=\"req\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"motif-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" id=\"paro-details\" aria-required=\"true\" aria-invalid=\"false\" name=\"motif-details\"><\/textarea><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>Reference in PeriodonticsPeriodontist Referral Form Please fill out the form below to refer a patient for a periodontal consultation with Dr. Rouzbeh Ostadsharif Memar, periodontist. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1684","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/centredentairedentown.com\/en\/wp-json\/wp\/v2\/pages\/1684","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/centredentairedentown.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/centredentairedentown.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/centredentairedentown.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/centredentairedentown.com\/en\/wp-json\/wp\/v2\/comments?post=1684"}],"version-history":[{"count":4,"href":"https:\/\/centredentairedentown.com\/en\/wp-json\/wp\/v2\/pages\/1684\/revisions"}],"predecessor-version":[{"id":1688,"href":"https:\/\/centredentairedentown.com\/en\/wp-json\/wp\/v2\/pages\/1684\/revisions\/1688"}],"wp:attachment":[{"href":"https:\/\/centredentairedentown.com\/en\/wp-json\/wp\/v2\/media?parent=1684"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}