Online Referral Form
You may refer patients to our office by filling out our referral form online, by e-mail, or by postage mail. Please make sure to email or attach all of the necessary records and x-rays to our office. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.
Referring Doctor Form
SEND REFERRAL FORMS TO:
If you prefer to submit your referral via paper form, please download the referral form below and return it to our office. Please send all forms to:
7711 Baymeadows Rd. E #7
Jacksonville, FL 32256
Phone: (904) 565-1505
Fax: (904) 565-1506
1495 Kingsley Ave.
Orange Park, FL 32073
Phone: (904) 272-8484
Fax: (904) 491-0222
REFERRING DOCTOR'S X-RAYS
If your dentist or physician has taken x-rays you may request that they forward them to our office. Simply have your dentist’s office email the films to firstname.lastname@example.org. If additional films are necessary they can be taken at our facility.
Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. Occasionally, surgery can be performed the same day as the consultation. However, a complex medical history or treatment plan may require an evaluation and a second appointment to provide treatment on another day. If you plan to have IV sedation for your surgery, please have nothing to eat or drink eight hours prior to your surgery. You will also need an adult to drive you home.
**IMPORTANT: All patients under the age of 18 must be accompanied by a parent or guardian at the consultation visit.
Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e., diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are currently taking any medications (i.e., heart medications, aspirin, anticoagulant therapy, etc.).