Dentist Referral Form
For your convenience, you may refer patients to our office using our online referral form. Simply fill out the form and press submit, and the information will be automatically sent to us via our secure, HIPAA-compliant server.
We also accept patient x-rays in JPEG format via email. Please send your forms to the email address associated with the office where your patients are being referred:
KENMORE & MILL CREEK REFERRAL FORMS
Email x-rays to: firstname.lastname@example.org
TRI-CITIES REFERRAL FORMS
Email x-rays to: email@example.com