Refer A Patient

Referral Form

WE OFFER SEDATION DENTISTRY FOR:

• Patients with anxiety and fear about dental care
• Patients who cannot control the gag reflex
• Patients who are resistant to, or cannot tolerate local anesthesia
• Patients with extensive treatment needs, who need rapid start and rapid completion

  • Patient Information

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Referral Information

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