Referral Recommendations

I appreciate the confidence you place in our office when you refer your patients. Our goal is to achieve a seamless transition, so patients feel like our office is just an extension of yours. To help us accomplish this goal, we recommend reviewing this checklist when referring a patient to us:

The more information we have, the better! Please advise your patient’s treatment needs along with any work that you have performed our planned so that we can provide the patient with consistent treatment planning.

Your patients should be advised that they will be seen first for an examination and their surgery will occur at a separate appointment. This way we can further reinforce suggestions as well as properly plan and diagnose both preoperatively and postoperatively. Financial arrangements will also be openly discussed.

Current xrays are helpful (within the last year). We welcome you to email them to us or provide them conventionally. We recommend an FMX over a PAN and prefer PA’s for specific cases.

We will expect and hope you can reinforce encouragement for your patients to continue care at your office while seeing us, even if it’s only for a restorative exam. This keeps them up-to-date in your office throughout their treatment here.

For patients on alternating recall between our offices, please make sure to forward copies of your xrays so we don’t inconvenience your patients by taking additional films.
I welcome your phone calls and emails to discuss treatment prior to your patients coming in. The more information we can share, the better care the patient can receive.

Online Doctor Referral Form

You may refer patients to the office by filling out our secure online Referral Form. After you have completed this form, please make sure to press the SUBMIT button at the to automatically send the information. If you wish, you may also print the form and ask the patient to bring in the printed form.

The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it. You may submit your xrays electronically by emailing them to us. Please email the xrays to

South Jersey Periodontics and Dental Implants Referral Form

Periodontal EvaluationImplantsExtraction (augmentation?)Sinus GraftingCrown LengtheningGingival GraftingOther

Take x-raysPatient has x-raysI will send x-raysReturn original x-rays

Click Here to download patient medical history forms