Doctor Referral Form
We appreciate your referrals
Thank you for entrusting us with the care of your patients. We are honored you have referred your patient to us. We are devoted to enhancing your patients’ health. We are committed to providing state-of-the-art treatment, and caring with genuine kindness and empathy. We consider our efforts successful when you and your patients are fully satisfied and we have exceeded your highest expectations. Please let us know if there is anything we can do to better facilitate optimal treatment.
Secure Online Referrals
You may refer patients to our Santa Barbara CA Oral Surgery office by filling out our Secure Online Referral Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. You will then have the option to securely upload and transmit images of patient X-Rays.
The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.
Printable Forms for Referring Doctors
You may refer patients to our Oral Surgery office by downloading, printing, and filling out our Referral Form. After you have completed the form, please give to the patient or send to our office.
Our PDF forms use Adobe Acrobat Reader. Please download Acrobat Reader free from Adobe’s web site if it is not already installed on your system.