Referring Doctors

You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

Please use this patient referral form for your patients:

  • Doctor Referral Form PDF

If you're unable to open PDF files, you can get Adobe Reader® for free.

Referral Information:

Bold Fields are required.

Location

           

 

PLEASE VERIFY YOUR INSURANCE COVERAGE BEFORE MAKING APPOINTMENT.
Patients under age 18 must be accompanied by parent or guardian.
If your dentist or physician has prescribed any medications for you, you may take them as prescribed with a small amount of water.

New Brighton Location Blaine Location Waconia Location Maple Grove Location Cambridge Location Edina Location