Secure Doctor Referral
Refer a Patient to Dr. Henry Assad
Complete the secure online orthodontic referral form below. Please include relevant clinical information and upload any available radiographs, photographs or supporting records.
- Secure online submission
- Upload supporting records
- Accessible at any time
- Referral support available
Patient Details
Enter identifying and contact information.
Clinical Concern
Describe the reason for referral.
Clinical Records
Upload relevant files when available.
Submit Securely
Review and send the completed referral.
Digital Referral Form
Dr. Henry Assad Online Referral
Please complete all applicable fields. The form will resize automatically as you progress through each section.
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Dr. Henry Assad Secure Referral Form
HIPAA Compliant Secured Portal
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Open Dr. Henry Assad Referral Form
Thank you for your referral
We appreciate the confidence you place in Dr. Henry Assad and the Sudbury Orthodontics team. We look forward to collaborating with your office in the care of your patient.