Online Referral Form
You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.
Thank you for the confidence you’ve expressed in us by referring patients to our office. So that we may better serve you and your patients, please fill out the referral slip as completely as possible. Below is a list of information that helps us in providing care for your patients as efficiently as possible.
- Tooth number
- If root canal treatment is present on the tooth
- Any special treatment requests (e.g. parapost, cotton pellet)
- If your patient needs antibiotic prophylaxis
- Comments you think would be beneficial in caring for your patients
If there are vague and/or unlocalized symptoms, please request an evaluation-only appointment. An evaluation appointment consists of a diagnosis and an explanation of treatment options.
We will report back to you with our findings via telephone and/or written correspondence with radiographs.