This section pertains to Dentists only.
       If you are a patient, please click the Patients button to your left.

Referrals:

For your convenience we have our referral form online for you to download and print. These forms are normally in triplicate with copies for Referral, Patient and Doctor. Please complete the referral with as much information as possible, this will eliminate unnecessary phone calls to your office.

When completing the referral form, please pay attention to the following items:

• Patient’s first and last name
• Patient’s home and work telephone numbers
• Is this a complete or limited exam?
• Area or tooth requiring evaluation
• Do you have restorative plans, if so what are they?
• Who will be completing the SRP or has it been already completed?
• Does the patient require pre-medication?
• Does the patient have dental insurance or any financial questions?

Please fax (843-971-1686) or mail a copy of the referral to our office to facilitate your patient’s evaluation. Please retain a copy of the completed referral form for your records.

Click on the link below, and then go to File and Print

Patient Referral Form

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