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Patient Referral

Please complete your referral form before your upcoming appointment. An automatic message will then be sent to you containing information about our practice, as well as your registration paperwork. 

* Required Fields

Patient Information

Procedures and Consultations

Referring Provider Information

Teeth Layout

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PDF and/or X-Rays

Upload PDF and/or X-rays

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Patient Instructions

  • Generally, we will see you for an evaluation prior to scheduling your oral surgical procedure. 

  • Minors must be accompanied by a parent or legal guardian. 

  • Please bring any pertinent X-rays. 

  • Please bring a list of any medications you are currently taking 

  • Please bring a list of drug allergies.

  • Please call if you have any questions before your appointment. 

  • If unable to keep your appointment, please give us a 24 hours notice.

Case Notes