THIS FORM IS REQUIRED-PLEASE HAVE THE LINKED REFERRAL FORM BELOW COMPLETED BY THE REFERRING PROVIDER

The following link is to our online referral and is required for patients coming to our practice for a CBCT. WITHOUT THIS FORM, WE MUST COMPLETE A COMPREHENSIVE EXAMINATION AND TAKE NECESSARY RADIOGRAPHS.

http://app.operadds.com/s/f/k4NO0

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