<p>Referring <strong>Doctors</strong></p>

Referring Doctors – Las Vegas & Henderson, NV

Referring Doctors

<p><strong>Official Oral and Facial Surgeons for</strong> The Vegas Golden Knights</p>

Official Oral and Facial Surgeons for The Vegas Golden Knights

We’re proud to be the go-to oral and facial surgeons for the Vegas Golden Knights for multiple years in a row.

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Patient Referral

Patient Referral Form

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Today's Date*

Date

Referred by Doctor*

First Name

Last Name*

Last Name

Doctor Phone Number*

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Doctor Email*

example@example.com

Patient Name

First Name

Last Name

Patient Date Of Birth*

Date

Patient Phone Number*

Please enter a valid phone number.

Please Evaluate & Treat

Extraction/Surgical Removal

All-On-4

Expose & Bond

Dental Implants

Bone Grafting

Virtual Consult

Other

File Upload – Upload Photos, X-Rays, or Other Files Related to Patient's Case

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Max. file size: 128 MB.

If uploading an X-Ray, when was the X-Ray last taken?

Date

Additional Comments

Accreditation which demonstrates a commitment to the highest level of patient safety, care, and quality that is held at the same standard as a hospital.

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