For referring dentists

Refer a patient in one short step.

The same card your front desk already uses, sent straight to us. We handle the surgical phase and return the patient with the components your restorative team needs.

The same card you already use, filled out on screen.

Your front desk can either hand the patient a physical card to bring in, or submit this form electronically. If submitted electronically, no physical card is needed — the form itself is the referral.

Patient first name*

Patient last name*

Patient date of birth (optional)

Patient phone*

Patient email*

Reason for referral*

If you submit this electronically, a physical card is not needed — this form itself is the referral. If you already gave the patient a card, it will speed up check-in.

Notes, Tooth # or Area

How should we coordinate with the patient?*

Referring doctor name*

Doctor email*

Doctor phone*

Review before sending

Tap any section to jump back and change an answer.

Sent securely to our front office. Prefer to talk? (718) 643-1953

Premium, research-backed implant systems

We place premium, research-backed implant systems, so your restorative team works with the familiar components and protocols they already trust.

Restorative-ready handbacks

Impression components, scan posts, and written guidance are provided to your office or lab so the restorative phase starts without guesswork.

Written consult summary

A written letter with diagnosis, images, and the proposed sequence, so you can plan the restorative side without chasing us.

Direct doctor access

Acute abscess, failing implant, or post-op question: call or text the office and we will put you through to a doctor and make room.