For Referring Offices
Referral Form
Referring doctors can securely send patient information to our office.
For Referring Offices
Before You Begin
Have the patient's details and referring doctor information ready. If the referral is urgent, please contact our office directly.
For Referring Offices
Referral Details
Select the insurance type and procedure being referred, then identify the relevant tooth or area and provide any helpful clinical notes.
For Referring Offices
X-Rays And Clinical Photos
Indicate the radiograph status and attach X-rays or clinical photos when available. Our office will follow up if additional information is needed.
Need Help?
Questions About This Form?
Call our Waterloo office if you are unsure which form applies or how to prepare before your appointment.
Forms FAQ
Questions About Referral Form
Who should use the referral form?
The referral form is intended for referring dental or medical offices sending patient information to the Waterloo oral surgery office.
What should be included with a referral?
Include the reason for referral, relevant radiographs when available, medical concerns, urgency, and contact details so the office can coordinate care.
Can referring offices call about urgent cases?
Yes. Referring offices should contact the office directly if a case is urgent or needs special coordination.
Ready to connect?
Call Our Office.
Directions
Online Map & Driving Directions
Visit our Waterloo oral and maxillofacial surgery office at 96 Union Street East. Open our Google Business Profile for directions, office details, and patient reviews before your appointment.
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