Patients referred to our practice may not have complex dental requirements but require sedation or anesthesia to deliver dental care.

They may have, but not limited to:

  • Anxiety, fear, or phobia of dentistry and its associated sound and/or equipment
  • Young children that are unable to cooperate
  • Difficulty getting numb with local anesthesia
  • Strong gag reflexes
  • Movement disorders, inability to be stationary
  • Physical and Mental disability
  • Extensive dental disease

 

Online Referral Form


Patients Name *
Patients Name
Patients Parents Name
Patients Parents Name
Patients Phone Number *
Patients Phone Number
Referring Dentists Name *
Referring Dentists Name
Treatment Options *
Radiographs *