Online Referral Form

You may refer oral surgery patients to our 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.

After you Submit your Referral, you will have the option to securely upload and transmit images of patient x-rays.

Online Referral Form

The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

If you have any problems or questions, please ask our staff. They are well informed and here to assist you. They can be reached by phone: North Oaks Office Phone Number 651-482-0065 for the North Oaks Office or Roseville Office Phone Number 651-636-2420 for the Roseville Office.