Please fill in the referral form below.
Optimal quality of dental care is the goal of every clinician. Achieving this goal requires a successful, honest and constructive collaboration between the referral dentist and the endodontist.
In our practice we undertake exclusively endodontic cases - microsurgical and non-surgical - always in direct contact with the referral dentist.
After the root canal treatment, the patient returns back to the referral dentist for the completion of the treatment plan. Also, a follow-up examination is performed in order to evaluate the therapeutic result.
Below you can see and fill in the patient's referral form. In case you wish to receive a hard copy booklet of referral forms, you can contact us at email@example.com.
Upper Right Quadrant
Upper Left Quadrant
Lower Right Quadrant
Lower Left Quadrant