Referring Doctors

Unlike some Periodontists, our goal is to work with you to ensure the best oral health of our patients. We ALWAYS send back patients post-surgery and communicate with you on treatment plans to ensure optimal results.

What Makes Us Different

  • We are very thorough in reviewing the patients’ General Dental and Medical History and how it might relate to their current chief complaint
  • We seek to communicate and work directly with their choice General Dentist
  • We communicate directly with their Medical Doctor when necessary including review of current blood work results
  • We are sensitive to patients concern about having surgery and offer treatment options that do not involve cutting of their gums
  • Oral sedation is available for those that are very anxious about coming to the Dentist
  • Oral Hygiene instruction is always reviewed and we believe is integral to the overall success of their treatment long-term

 

Online Referral Form
  • Location*Requested Location
    Silver Spring, MD
    Bowie, MD
    0
  • Patient Information
    1
  • First Name*
    2
  • Last Name*
    3
  • Date*
    4
  • Referring Doctor Information
    5
  • Referred By*
    6
  • Phone Number*
    7
  • Email*
    8
  • Reason for Referral
    9
  • *
    Gummy Smile
    Ridge Augmentation
    Emergency/Abscess
    Biopsy/Oral Lesion
    TMJ/Oral-Facial Pain
    Loose Teeth
    Bad Breath
    10
  • *
    Comprehensive Periodontal Evaluation
    Implants
    - Wax-up provided
    - Wax-up needed
    Orthodontic Co-Therapy/Tooth Exposure
    Gingival Recession
    Crown Lengthening
    11
  • Other Service*
    12
  • Associated with Teeth / Area*
    13
  • Radiographs
    14
  • *
    FMX
    PANO
    BWX
    PAX
    None
    15
  • *
    CONE BEAM
    Being Mailed
    Being E-Mailed
    Given to Patient
    16
  • Periodontal Treatment Completed In Your Office
    17
  • *
    Plaque Control Instruction
    Prophylaxis
    Gross Scaling
    Root Planing
    Root Planing with local anesthetic
    Routine Periodontal Maintenance
    18
  • Date of Treatments*Please provide the date of last treatment for the checked off boxes above.
    19
  • Specific Restorative Treatment Plan and/ or Instructions
    20
  • *Please provide us with any additional information or instructions.
    21
  • 22
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