Referral Forms for Dentist Offices

Thank you for referring your patient, and for your confidence in our office.  

An initial examination is required for every new patient. This may be limited or comprehensive, depending on the nature of the referral. Please note that for a Comprehensive Periodontal Exam, an FMX is preferred. Please include with your referral any relevant clinical information, such as periocharting, case notes, etc.

It is our goal to complete our cases in a timely manner and to be respectful of your time, as well as the patient’s.

After your patient is seen, we will report to you the periodontal findings, diagnosis, and recommended treatment.

  • Referral Form PDF

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OsseoAmerican Academy Of PeriodontologyAmerican Dental Association