WE WANT YOU TO KNOW THAT WE ARE HERE TO SUPPORT YOU AND YOUR PATIENTS WITH ALL DENTAL EMERGENCIES.
For your convenience, you may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.
You may also email the completed form to firstname.lastname@example.org, fax it to 503-652-8992, or mail it to our office at 9895 SE Sunnyside Rd, Suite P, Clackamas, OR 97015.
Online Referral Form