Physician's Referral Form

At the Center for Specialized Dentistry, we value our relationships with referring dental practices and are proud to partner with you in providing excellent oral healthcare to all.

Please either complete the referral form by downloading and printing or the fillable features below.

When referring a patient to our practice please know:

  • We, will review the case thoroughly in advance
  • We, will refer back to your practice for restorations
  • We, will collaborate with you on treatment plans
  • We, are available in an advisory role if required
  • We, offer accommodating scheduling
  • We, provide timely assessments and imaging

Above all, on behalf of Dr. John Louis and the staff at The Center for Specialized Dentistry we want to thank you for your continued confidence in our office.

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Please do not submit any Protected Health Information (PHI).