Dentist Referral

Are you a dentist or dental provider looking to refer a patient to our periodontal specialist? Refer periodontics patients to our periodontist by using our secure online form.

    Please provide specialist with appropriate details of problem; i.e. urgency, areas of concern, using F.D.I. tooth numbering system.
    Indicate any special factors –either dental or medical –such as allergies and medical problems relevant to diagnosis and treatment.


    Date of Referral