Referral Form

The Dederich Dental Clinic is Dr. Douglas Dederich’s part-time Periodontal Disease Management & Surgical Clinic as he is a full professor at the University of Alberta and Co-Director of the UofA Graduate Periodontal Surgical Residency. 

This office does NOT provide general dental services.

Referral Form  (For Referring Dentist Use - Please return via fax: 780-437-7757 or email to