Referral Information
If the referral form is available below or the referral link is active, we are currently accepting referrals. If the form or link is not available, please check back at a later date.
Referral Policy:
- All referrals must be for patients 9 years old or younger.
- We are unable to serve as the ongoing dental home for patients with Primary Medicaid. However, we may be able to provide needed treatment on a “treat and release” basis. This allows us to provide care when needed while helping us serve more children who need specialized pediatric dental services.
- Availability is limited, and referral acceptance may be paused periodically as needed.
Download and complete our referral form, then send it to our office.