DENTAL REFERRAL FORM

Submission for Dental and Medical Providers

We welcome referrals from dentists, orthodontists, physicians, and other healthcare professionals. Use our secure online form to refer your patient for surgical care.

Simple, Confidential, And Efficient

Our referral form is designed to make the process smooth for both providers and patients. You can upload X-rays or additional documentation directly through the form.

Once submitted, your referral is sent securely to our administrative team, who will coordinate directly with the patient to schedule their consultation or procedure.

Referrals are commonly made for:

  • Extractions or wisdom teeth
  • Dental implants or bone grafting
  • TMJ concerns or jaw surgery
  • Oral pathology
  • Sinus lifts or zygomatic implants
  • Pre-surgical assessments

If you prefer, referrals may also be faxed to our office. Please contact us if you need assistance.

Ready to Submit A Referral?

Please complete the form and submit it using one of the following methods:

Radiographs may be sent securely to the clinic via:

  • CDA Secure Send
  • WeTransfer (for large digital files)
Download the form

Protecting Your Patient’s Information

We take the security and confidentiality of patient data seriously. All referrals submitted through our online form are encrypted and comply with applicable privacy standards.