Dentists Referral Form

Referring For:

Dental implants, sinus lifts & block graftingI.V. and Inhalation sedationOral & third molar surgeryAesthetic / cosmetic and advanced restorative dentistryPeriodontal surgery & microsurgeryEndodontics & micro-endodonticsNervous patient management

The Patient is Experiencing:

Failed bridgeworkUnsightly spacesLoose denturesDifficulty chewingPeriodontal problemsFailing post crown

I would like to arrange a joint treatment plan for this patient

I would like to do the restorative work on the implant(s)