Referring Providers

We welcome referrals and always look forward to collaborating with other health professionals. Feel free to call any time if there are questions regarding patient care.

For new patients to our practice, we appreciate sending any radiographs, chart notes, and referral information prior to patient scheduling. Feel free to send us this information below via the online form or through our referral email address, or fill out a referral pad paper and email us a copy. We will be happy to reach out to the patient to schedule the appointment. Thank you!

referrals@troypediatricdentist.com
Office Phone: (636)-383-4500

Referring Office and Doctor

Patient Name

First Name

Last Name

Radiographs

Radiographs taken and sent via separate email attachment

No Radiographs being sent

Treatment Rendered at Initial Appointment and DATE

Referral (Teeth of Concern, Patient History, Sedation Needed, etc.)

Parent Contact

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