Doctor Referral

We welcome and appreciate your referrals and will always pay close attention to any special details or instructions. To download and print our referral form please choose and click the title below.

If you have any questions, please feel free to call our office at 847-870-0475.

Referring Doctor Form

See what our patients are saying

"Where do I even begin. My daughter who had been seen by her pervious dentist for 3 years, was denied services and treatment while she was experiencing pain/sensitivity to a number of teeth. I found Algoqnuin Kids Dentistry, and I’m so glad I did. From scheduling to completing forms to the practice itself, exceeded my expectations. Let me start first with the gentleman upfront. He is beyond kind and friendly. He almost makes you feel as though he has known you forever. The dental assistant took the time to hear our concerns and fears. She never once made my daughter feel uncomfortable or disregarded her feelings and pain. She did a great job explaining step-by-step how she was going to clean her teeth and even put her favorite show on to easy her mind. Dr. Ursitti, I don’t even have words. She is selfless, kind, gentile and humble. We absolutely adore her! She is the most amazing dentist. She educated us on the best treatment plan for my daughter, and did some of her treatment that day because she didn’t want my daughter to be in pain anymore. She cares so much about her patients and their health she will go to the end to do what’s best. It’s not about how much she can make off the patients but the overall experience and health. She has just gained 5 new patients for sure. I left the office emotional, but of joy, and satisfaction. Thank you, thank you, thank you! If you are looking for a confident, amazing, caring dental team for your kids, please look no further. Please call Algoqnuin Kids Dentistry! True PATIENT CARE!!!!"L. U.

"Dr Ursitti and her team were absolutely fabulous! They handled my son’s first visit with care and compassion and they made both of us feel extremely comfortable. I wish they could take me on as a patient as well! Lol As a parent, that had terrible dentist experiences as a child and not so great ones as an adult, I’m so so thankful my son has a knowledgeable and caring dentist with a phenomenal staff to take care of him for a long time."J. S.

"Beyond five stars! Dr. Ursitti is amazing. My little guy had an appointment today and unfortunately he isn't very cooperative so we had to opt for anesthesia. She did an amazing job on his teeth. She is thorough and communicates everything to you prior to even starting. When he awoke from the anesthesia I witnessed the most heart-warming sight I have ever seen. As I made my way to the room Dr. Ursitti was soothing and holding my child. Anyone knows when a child wakes up from being put under it is very tough on them emotionally. As a parent you want your child to be in the best hands possible and she is it. She treated my son as if he were her own and definitely went above and beyond for him. Thank you so much Doctor for making a stressful situation so much easier for us!"S. R.