Whether you are a general practitioner, dentist, orthodontist, ENT specialist, osteopath or other health care provider, I welcome and appreciate your referrals. When you refer to Grey Bruce OMT, you can expect a high level of care for your patients and open communication.

Please Note

We do have a 6 month waitlist, so when referring your patients please make them aware of this. Thank you!

Patient Name *

First Name

Last Name

Parent/Guardian Name (If under 18)

Age of Patient *

Email (if available)

Phone Number *

Referring Provider Name & Office *

Referring Provider Phone & Email *

Reason for referral:

Check all that apply*

Tongue Tie

Lip Tie

Tongue Thrust

Mouth Breathing

Oral Habit(s)

Lip Incompetence

Orthodontic Retention/Relapse

Symptoms of Sleep Disordered Breathing

Clenching or Grinding

TMJ Symptoms

Low Muscle Tone

Speech Concerns

Other

Additional Information

Please rate your patient's level of urgency to be seen: *

Low

Moderate

High

Thank you for your referral! I look forward to collaborating with you to address your patient’s needs.

Grey Bruce OMT

Contact

Jessica David, RDH, Orofacial Myofunctional Therapist
(226) 678-8640
jess@greybruceomt.com

Bookings are currently closed. Visit CONTACTs page to join the waitlist

Location

Practicing Within Hanover Physiotherapy & Sports Rehabilitation
140 7th Ave Suite 2, Hanover, ON N4N 2G9

⭐️ Proud member of the IAAH, ODHA and CDHA!

Socials

Follow on Facebook and Instagram @GreyBruceOMT

*The information on this website is for educational and informational purposes only, and should not be used as medical advice, diagnosis or treatment.