Refer Your Patients to the Dream Team

Seamless Referrals for Coordinated Dental Care

Are you a dentist or physician referring a patient to our office? Please complete the referral form below with the necessary details about your patient. After submitting the form, we will follow up to coordinate the next steps in treatment. We prioritize clear communication to ensure the best possible outcomes for every patient. Thank you for your trust in us, and for your partnership in providing excellent care.

Please note, this form is for use by medical professionals only. If you are a patient referring another patient, then please use the friends and family referral form here.

Name of Office(Required)

Office Phone(Required)

Office Fax

Office Website

Patient Name(Required)

First Last

Patient Phone(Required)

Patient Email

Patient Referral Reason

Important! Do not upload Protected Health Information (PHI) via this form. Contact our office if you need to transfer patient medical records.

Upload Patient Documents
Max. file size: 50 MB.

Questions? Please contact our office staff. Thank you.

Phone: (425) 258-6429

Fax: (425) 339-9145

Email: [email protected]