Refer A PATIENT
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.
We encourage you to contact our office should you have a patient who requires treatment or wishes to discuss dental implants, wisdom teeth extraction, office based anesthesia, bone/soft tissue grafting, or any other oral surgery need. We will make every effort to see the patient as quickly as possible.
The referral form below can be filled out and emailed to [email protected] or faxed to (281) 362-7178. Please contact our office should you have any additional questions.