Office Referrals

Patient Information

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    Referring Doctor Information

    Oral Surgery
    Endodontics
    Periodontics
    Anesthesia

    Patients requiring General Anesthetic or I.V. Sedation are seen for consultation prior to procedure

    Surgical Template
    Extractions Teeth 1
    R L
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    Extractions Teeth 2
    R L
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    Doctor's Notes

    “I felt welcomed and comfortable every time I visited.”

    Grace M., Pleasant Prairie