This referral form is designed to maintain and improve communication between our practices. Please print the form below and use the following guidelines to maximize our referral system.
  • For best results, please contact our office with the patient present to schedule an appointment
  • Fill out the referral form with the appointment information and the requested consultation/procedures
  • Give the referral form to the patient
  • Please make a copy of the referral form for your records
  • If an appointment is not scheduled, please email or fax us the patient’s information and per your request we can contact the patient directly to schedule an appointment
  • Please contact our office if you have any additional questions

We appreciate your referrals.

Oklahoma Center for Implants & Periodontics

Click here to download our Referral Form