Phone Call Request

Thank you for your interest in an orthodontic consultation with Dr. Mir. Please complete this form to request a call back. The information you will provide remains confidential and it is intended to help us give you or your child the smile you've been waiting for.

Thank you,
York Orthodontics Team
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Phone number *
First & Last name of the patient: *
Email Address:
We would like to send you an email to confirm your appointment along with instructions for direction and parking.
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