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New Patient and Referral Forms

We appreciate and are thankful to you for choosing the services of Dr. Miriam Grushka. We are a team of trusted oral medicine professionals specializing in issues of the mouth, orofacial pain and temporomandibular joint (TMJ) treatments. If you are a new patient, kindly fill out the below new patient form before you visit us for your initial examination. 

New Patient Form

We accept referrals from other providers for their patients who require specific treatment for mouth and jaw injuries. If you have a referral from an outside provider or if you are a medical practitioner referring one of your patients to us, kindly download and fill out the below referral form. We can get in touch with the referred patient to schedule an appointment on an appropriate date.

Referral Form

Kindly forward the filled forms to us directly through:
Email:, or
Fax: 416-656-8328

To schedule an urgent appointment, for queries, and for any information you require regarding our orofacial services, get in touch or visit our clinic today.

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