Referral Form
Thank you for including us as part of your patient’s oral health care team.
Our goal is to provide exceptional treatment and to have open communication with you for the best outcome for your patients.
We will make every effort to provide a comfortable and anxiety-free visit for your patient.
Our patient software allows you, as the referring doctor, to view your patient’s chart, images (including the CBCT), and post-op letters.
You can even message us and refer patients directly through the program.
Already have a login?
Click here to Log-in to DentalEMR
Don’t have a login yet?
Just contact us and we will send you an invite.
Or, download this PDF, print it...
and then complete the form by hand.
Relief is right around the corner. We are here for you Chicagoland!
Serving Willowbrook, Burr Ridge, Darien, Hinsdale, Clarendon Hills, Westmont, Western Springs, LaGrange, LaGrange Highlands, Countryside, Oak Brook, and the greater Chicagoland area
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