e recognize and value the quality of care provided by our dental community of professionals. And we appreciate working with many of you to supplement the treatment of your patients.

Through our Referring Physicians relationship, you’re able to communicate and send us referrals for treatment in our clinic.

By using our dedicated email and fax links, you can:

  • Easily communicate with us more directly
  • Refer your patients.
  • Send us supporting elements such as images, x-rays, and PDFs as allowed by HIPAA restrictions.
  • Exchange information on the patient’s treatment program.
  • Ask us about the treatment status of our patients in your own clinics.

Please be aware that we adhere to all current HIPAA laws regarding patient privacy and ask that you send us personal information through our fax or by regular mail or courier as appropriate.

Click below to fill out online and then download your filled-in form and fax or email to us. Or you may also download our introductory doctor’s referral form, fill in and submit.

This only needs to be submitted once per practice and can be faxed to 602.992.8897

Physicians

       Referring Physician Form